Provider Demographics
NPI:1174734099
Name:ALEXANDER JR. HIGH SCHOOL
Entity type:Organization
Organization Name:ALEXANDER JR. HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:601-833-6661
Mailing Address - Street 1:PO BOX 540
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:39602-0540
Mailing Address - Country:US
Mailing Address - Phone:601-833-6661
Mailing Address - Fax:601-833-4154
Practice Address - Street 1:ALEXANDER JR HIGH SCHOOL
Practice Address - Street 2:713 BEAUREGARD ST.
Practice Address - City:BROOKHAVEN
Practice Address - State:MS
Practice Address - Zip Code:39601
Practice Address - Country:US
Practice Address - Phone:601-833-7549
Practice Address - Fax:601-835-5467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09016151Medicaid