Provider Demographics
NPI:1821156985
Name:SANTA ROSA COUNTY SCHOOLS
Entity Type:Organization
Organization Name:SANTA ROSA COUNTY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRACEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-983-5587
Mailing Address - Street 1:6751 BERRYHILL ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-4790
Mailing Address - Country:US
Mailing Address - Phone:850-983-5151
Mailing Address - Fax:850-983-5577
Practice Address - Street 1:6751 BERRYHILL ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-4790
Practice Address - Country:US
Practice Address - Phone:850-983-5151
Practice Address - Fax:850-983-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL081005315Medicaid