Provider Demographics
NPI:1396082129
Name:ROCK CREEK GRANT SCHOOL
Entity type:Organization
Organization Name:ROCK CREEK GRANT SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL PRINCIPAL/SUPT
Authorized Official - Prefix:MR
Authorized Official - First Name:CLYDE
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:NAASZ
Authorized Official - Suffix:
Authorized Official - Credentials:SPECIALIST
Authorized Official - Phone:605-823-4971
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD
Mailing Address - State:SD
Mailing Address - Zip Code:57642-0227
Mailing Address - Country:US
Mailing Address - Phone:605-823-4971
Mailing Address - Fax:605-823-4350
Practice Address - Street 1:1 INDIAN SCHOOL DRIVE
Practice Address - Street 2:BOX 227
Practice Address - City:BULLHEAD
Practice Address - State:SD
Practice Address - Zip Code:57621-0227
Practice Address - Country:US
Practice Address - Phone:605-823-4971
Practice Address - Fax:605-823-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes347C00000XTransportation ServicesPrivate Vehicle
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchoolGroup - Multi-Specialty
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchoolGroup - Multi-Specialty
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchoolGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty