Provider Demographics
NPI:1366677569
Name:PLEASANT GROVE INDEPENDENT SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PLEASANT GROVE INDEPENDENT SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHALEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-831-4086
Mailing Address - Street 1:8500 N KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-4893
Mailing Address - Country:US
Mailing Address - Phone:903-831-4086
Mailing Address - Fax:903-831-4435
Practice Address - Street 1:8500 N KINGS HWY
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-4893
Practice Address - Country:US
Practice Address - Phone:903-831-4086
Practice Address - Fax:903-831-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065581301Medicaid