Provider Demographics
NPI:1508079518
Name:CANON ELEMENTARY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:CANON ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:ELKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-374-5588
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:34630 S SCHOOL LOOP RD
Mailing Address - City:BLACK CANYON CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85324-0089
Mailing Address - Country:US
Mailing Address - Phone:623-374-5588
Mailing Address - Fax:
Practice Address - Street 1:34630 S SCHOOL LOOP RD.
Practice Address - Street 2:
Practice Address - City:BLACK CANYON CITY
Practice Address - State:AZ
Practice Address - Zip Code:85324-0089
Practice Address - Country:US
Practice Address - Phone:623-374-5588
Practice Address - Fax:623-374-5046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ55820825OtherUSER ID