Basic Information
| Provider Information | |||||||||
| NPI: | 1881020873 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GRAND VIEW SCHOOL | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 15481 N JARVIS RD | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744640233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184565131 | ||||||||
| FaxNumber: | 9184561526 | ||||||||
| Practice Location | |||||||||
| Address1: | 15481 N JARVIS RD | ||||||||
| Address2: | |||||||||
| City: | TAHLEQUAH | ||||||||
| State: | OK | ||||||||
| PostalCode: | 744640233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184565131 | ||||||||
| FaxNumber: | 9184561526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2013 | ||||||||
| LastUpdateDate: | 09/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | KENNEDY | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | ED | ||||||||
| AuthorizedOfficialTitleorPosition: | SUPERINTENDENT | ||||||||
| AuthorizedOfficialTelephone: | 9184565131 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251300000X | Y | Agencies | Local Education Agency (LEA) |
No ID Information.