Provider Demographics
NPI:1811189103
Name:FREDONIA-MOCCASIN UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:FREDONIA-MOCCASIN UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DORENE
Authorized Official - Middle Name:HEATON
Authorized Official - Last Name:MUDROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-643-7333
Mailing Address - Street 1:221 EAST HORTT STREET
Mailing Address - Street 2:PO BOX 247
Mailing Address - City:FREDONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:86022
Mailing Address - Country:US
Mailing Address - Phone:928-643-7333
Mailing Address - Fax:928-643-7044
Practice Address - Street 1:221 EAST HORTT STREET
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:AZ
Practice Address - Zip Code:86022
Practice Address - Country:US
Practice Address - Phone:928-643-7333
Practice Address - Fax:928-643-7044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)