Provider Demographics
NPI:1790909125
Name:SUPT OF HORATIO HIGH
Entity Type:Organization
Organization Name:SUPT OF HORATIO HIGH
Other - Org Name:HORATIO SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-832-2341
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:HORATIO
Mailing Address - State:AR
Mailing Address - Zip Code:71842-0435
Mailing Address - Country:US
Mailing Address - Phone:870-832-2341
Mailing Address - Fax:870-832-2174
Practice Address - Street 1:205 ISBELL ST
Practice Address - Street 2:
Practice Address - City:HORATIO
Practice Address - State:AR
Practice Address - Zip Code:71842-0435
Practice Address - Country:US
Practice Address - Phone:870-832-2341
Practice Address - Fax:870-832-2174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR6703251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR130753742Medicaid