Provider Demographics
NPI:1679693964
Name:CEDARVILLE HIGH SCHOOLS
Entity type:Organization
Organization Name:CEDARVILLE HIGH SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION LEA
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-474-6136
Mailing Address - Street 1:9500 PIRATES POINT
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72932
Mailing Address - Country:US
Mailing Address - Phone:479-474-6136
Mailing Address - Fax:
Practice Address - Street 1:9500 PIRATES POINT
Practice Address - Street 2:
Practice Address - City:CEDARVILLE
Practice Address - State:AR
Practice Address - Zip Code:72932
Practice Address - Country:US
Practice Address - Phone:479-474-6136
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR139374742Medicaid