Provider Demographics
NPI:1174660138
Name:SAN JUAN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SAN JUAN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL ED PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:P
Authorized Official - Last Name:DONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-678-1222
Mailing Address - Street 1:200 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLANDING
Mailing Address - State:UT
Mailing Address - Zip Code:84511-3600
Mailing Address - Country:US
Mailing Address - Phone:435-678-1222
Mailing Address - Fax:435-678-1390
Practice Address - Street 1:200 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BLANDING
Practice Address - State:UT
Practice Address - Zip Code:84511-3600
Practice Address - Country:US
Practice Address - Phone:435-678-1222
Practice Address - Fax:435-678-1390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000545628Medicaid