Provider Demographics
NPI:1649457151
Name:PINON UNIFIED SCHOOL DISTRICT #4
Entity type:Organization
Organization Name:PINON UNIFIED SCHOOL DISTRICT #4
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:YAZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-725-2130
Mailing Address - Street 1:PO BOX 839
Mailing Address - Street 2:
Mailing Address - City:PINON
Mailing Address - State:AZ
Mailing Address - Zip Code:86510-0839
Mailing Address - Country:US
Mailing Address - Phone:928-725-2130
Mailing Address - Fax:928-725-2135
Practice Address - Street 1:1 MILE NORTH BIA-41
Practice Address - Street 2:
Practice Address - City:PINON
Practice Address - State:AZ
Practice Address - Zip Code:86510
Practice Address - Country:US
Practice Address - Phone:928-725-2130
Practice Address - Fax:928-725-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ593055Medicaid