Provider Demographics
NPI:1679231500
Name:MORENO VALLEY HIGH SCHOOL
Entity Type:Organization
Organization Name:MORENO VALLEY HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-377-3100
Mailing Address - Street 1:PO BOX 1037
Mailing Address - Street 2:
Mailing Address - City:ANGEL FIRE
Mailing Address - State:NM
Mailing Address - Zip Code:87710-1037
Mailing Address - Country:US
Mailing Address - Phone:575-377-3100
Mailing Address - Fax:
Practice Address - Street 1:56 CAMINO GRANDE
Practice Address - Street 2:
Practice Address - City:ANGEL FIRE
Practice Address - State:NM
Practice Address - Zip Code:87710-8771
Practice Address - Country:US
Practice Address - Phone:575-377-3100
Practice Address - Fax:575-377-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health