Provider Demographics
NPI:1700935319
Name:SUPERINTENDENT OF CALICO ROCK HIGH SCHOOL
Entity Type:Organization
Organization Name:SUPERINTENDENT OF CALICO ROCK HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-297-8339
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:301 COLLEGE STREET
Mailing Address - City:CALICO ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72519-0220
Mailing Address - Country:US
Mailing Address - Phone:870-297-8339
Mailing Address - Fax:870-297-3168
Practice Address - Street 1:301 COLLEGE STREET
Practice Address - Street 2:
Practice Address - City:CALICO ROCK
Practice Address - State:AR
Practice Address - Zip Code:72519-0220
Practice Address - Country:US
Practice Address - Phone:870-297-8339
Practice Address - Fax:870-297-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)