Provider Demographics
NPI:1710178264
Name:SUPERINTENDENT OF BRINKLEY HIGH SCHOOL
Entity Type:Organization
Organization Name:SUPERINTENDENT OF BRINKLEY HIGH SCHOOL
Other - Org Name:BRINKLEY SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCGRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-734-5000
Mailing Address - Street 1:200 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:BRINKLEY
Mailing Address - State:AR
Mailing Address - Zip Code:72021-3400
Mailing Address - Country:US
Mailing Address - Phone:870-734-5010
Mailing Address - Fax:870-734-5187
Practice Address - Street 1:400 WEST LYNN
Practice Address - Street 2:
Practice Address - City:BRINKLEY
Practice Address - State:AR
Practice Address - Zip Code:72021-3400
Practice Address - Country:US
Practice Address - Phone:870-734-5010
Practice Address - Fax:870-734-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR121473761Medicaid