Provider Demographics
NPI:1891910675
Name:HUMBOLDT UNIFIED SCHOOL DISTRICT #22
Entity Type:Organization
Organization Name:HUMBOLDT UNIFIED SCHOOL DISTRICT #22
Other - Org Name:GROUP AHCCCS ID #551615
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:B
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:928-759-4028
Mailing Address - Street 1:8766 E HWY 69
Mailing Address - Street 2:SSO
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314
Mailing Address - Country:US
Mailing Address - Phone:928-759-4028
Mailing Address - Fax:928-759-4030
Practice Address - Street 1:8766 E HWY 69
Practice Address - Street 2:ATTN DONNA THAXTON SPECIAL SERVICES OFFICE
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314
Practice Address - Country:US
Practice Address - Phone:928-759-4028
Practice Address - Fax:928-759-4030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN025333163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ551615Medicaid