Provider Demographics
NPI:1205845609
Name:PROVO CITY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PROVO CITY SCHOOL DISTRICT
Other - Org Name:PROVO EARLY EDUCATION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:FACILITATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:COLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-374-4965
Mailing Address - Street 1:100 N 600 E
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84606-3315
Mailing Address - Country:US
Mailing Address - Phone:801-374-4965
Mailing Address - Fax:801-374-4881
Practice Address - Street 1:100 N 600 E
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84606-3315
Practice Address - Country:US
Practice Address - Phone:801-374-4965
Practice Address - Fax:801-374-4881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTHT000004Medicaid