Provider Demographics
NPI:1770678401
Name:KINGMAN ACADEMY OF LEARNING
Entity Type:Organization
Organization Name:KINGMAN ACADEMY OF LEARNING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NCLB/SPECIAL PROGRAM COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:COLVIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-681-2400
Mailing Address - Street 1:2299 E BEVERLY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86409-0736
Mailing Address - Country:US
Mailing Address - Phone:928-681-2400
Mailing Address - Fax:928-681-2424
Practice Address - Street 1:2299 E BEVERLY AVE
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86409-0736
Practice Address - Country:US
Practice Address - Phone:928-681-2400
Practice Address - Fax:928-681-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
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
AZ585888Medicaid