Provider Demographics
NPI:1760688683
Name:COLORADO RIVER UNION HIGH SCHOOL DISTRICT #2
Entity Type:Organization
Organization Name:COLORADO RIVER UNION HIGH SCHOOL DISTRICT #2
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-768-1665
Mailing Address - Street 1:5221 S HIGHWAY 95
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86426-9236
Mailing Address - Country:US
Mailing Address - Phone:928-768-1665
Mailing Address - Fax:928-768-1702
Practice Address - Street 1:2251 HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6089
Practice Address - Country:US
Practice Address - Phone:928-758-3916
Practice Address - Fax:928-758-7145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ585945251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ585945Medicaid