Provider Demographics
NPI:1942427562
Name:CITY OF CHARLESTON SUPT OF SCHOOLS DISTRICT 9
Entity Type:Organization
Organization Name:CITY OF CHARLESTON SUPT OF SCHOOLS DISTRICT 9
Other - Org Name:AKA-CHARLESTON SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:STUBBLEFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-965-7160
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:AR
Mailing Address - Zip Code:72933
Mailing Address - Country:US
Mailing Address - Phone:479-965-7160
Mailing Address - Fax:479-965-9989
Practice Address - Street 1:125 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:AR
Practice Address - Zip Code:72933
Practice Address - Country:US
Practice Address - Phone:479-965-7160
Practice Address - Fax:479-965-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1942427562103TS0200X, 163WS0200X
AR2402251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161906761Medicaid
AR146889743Medicaid
AR158506791Medicaid