Provider Demographics
NPI:1659599546
Name:WHITERIVER UNIFIED SCHOOL DISTRICT NO. 20
Entity Type:Organization
Organization Name:WHITERIVER UNIFIED SCHOOL DISTRICT NO. 20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:PETTIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-338-4842
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:WHITERIVER
Mailing Address - State:AZ
Mailing Address - Zip Code:85941-0190
Mailing Address - Country:US
Mailing Address - Phone:928-338-4842
Mailing Address - Fax:928-338-1924
Practice Address - Street 1:959 SOUTH CHIEF AVENUE
Practice Address - Street 2:
Practice Address - City:WHITERIVER
Practice Address - State:AZ
Practice Address - Zip Code:85941-0190
Practice Address - Country:US
Practice Address - Phone:928-338-4842
Practice Address - Fax:928-338-1924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
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
AZ626971Medicaid