Provider Demographics
NPI:1326069147
Name:JORDAN SCHOOL DISTRICT
Entity Type:Organization
Organization Name:JORDAN SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-567-8363
Mailing Address - Street 1:9361 S 300 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-2902
Mailing Address - Country:US
Mailing Address - Phone:801-567-8360
Mailing Address - Fax:801-412-2517
Practice Address - Street 1:7501 S 1000 E
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-2909
Practice Address - Country:US
Practice Address - Phone:801-412-2535
Practice Address - Fax:801-412-2517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT876000545020251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT876000545020Medicaid