Provider Demographics
NPI:1831240530
Name:GLEN ROSE SCHOOL DISTRICT
Entity type:Organization
Organization Name:GLEN ROSE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-332-6764
Mailing Address - Street 1:14334 HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:AR
Mailing Address - Zip Code:72104-7328
Mailing Address - Country:US
Mailing Address - Phone:501-332-6764
Mailing Address - Fax:
Practice Address - Street 1:14334 HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:AR
Practice Address - Zip Code:72104-7328
Practice Address - Country:US
Practice Address - Phone:501-332-7521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR155971732Medicaid
AR163429761Medicaid
AR117173743Medicaid