Provider Demographics
NPI:1164618484
Name:ARROWHEAD UNION HIGH SCHOOL
Entity Type:Organization
Organization Name:ARROWHEAD UNION HIGH SCHOOL
Other - Org Name:STONE BANK SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:BS, MSE, PHD
Authorized Official - Phone:262-369-3611
Mailing Address - Street 1:700 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:WI
Mailing Address - Zip Code:53029-1143
Mailing Address - Country:US
Mailing Address - Phone:262-369-3611
Mailing Address - Fax:262-367-2014
Practice Address - Street 1:N68W33866 HWY K
Practice Address - Street 2:
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-1442
Practice Address - Country:US
Practice Address - Phone:262-369-3611
Practice Address - Fax:262-367-2014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44209600Medicare PIN