Organization
COUNTY OF CANYON SCHOOL DISTRICT CLASS B 136J
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD KENNETH LEVESQUE (SYSTEMS MANAGER)
(208) 922-3093
Entity
Organization
Contact information
Practice address
520 BROADWAY AVE, MELBA, ID 83641
(208) 495-1141
(208) 495-1142
Mailing address
176 E CALDERWOOD DR STE 100, MERIDIAN, ID 83642-9097
(208) 922-3093
(208) 922-9351
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806406400
—
ID
Enumeration date
01/31/2007
Last updated
07/13/2008
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