Provider Demographics
NPI:1275726689
Name:BULLHEAD CITY ELEMENTARY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BULLHEAD CITY ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJE
Authorized Official - Middle Name:DON
Authorized Official - Last Name:HOOKSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-758-3961
Mailing Address - Street 1:1004 HANCOCK ROAD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5946
Mailing Address - Country:US
Mailing Address - Phone:928-758-3961
Mailing Address - Fax:928-758-4996
Practice Address - Street 1:1004 HANCOCK ROAD
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5946
Practice Address - Country:US
Practice Address - Phone:928-758-3961
Practice Address - Fax:928-758-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-20
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ585713390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty