Provider Demographics
NPI:1730216839
Name:MOHAVE VALLEY ELEM. SCHOOL DISTRICT
Entity type:Organization
Organization Name:MOHAVE VALLEY ELEM. SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUCEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-768-2507
Mailing Address - Street 1:8450 SOUTH OLIVE DR.
Mailing Address - Street 2:
Mailing Address - City:MOHAVE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86440
Mailing Address - Country:US
Mailing Address - Phone:928-768-2507
Mailing Address - Fax:
Practice Address - Street 1:1797 LA ENTRADA DR
Practice Address - Street 2:
Practice Address - City:FORT MOHAVE
Practice Address - State:AZ
Practice Address - Zip Code:86426-9379
Practice Address - Country:US
Practice Address - Phone:928-704-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN087148390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Multi-Specialty