Provider Demographics
NPI:1538150081
Name:BONNEVILLE SCHOOL DIST #93
Entity type:Organization
Organization Name:BONNEVILLE SCHOOL DIST #93
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR SPECIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-525-4414
Mailing Address - Street 1:3549 N AMMON RD
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-1301
Mailing Address - Country:US
Mailing Address - Phone:208-525-4414
Mailing Address - Fax:208-525-4487
Practice Address - Street 1:3549 N AMMON RD
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-1301
Practice Address - Country:US
Practice Address - Phone:208-525-4414
Practice Address - Fax:208-525-4487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty