1215114723 NPI number — COUNTY OF MARICOPA - MARICOPA COUNTY SCHOOL DIST 24

Table of content: (NPI 1215114723)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215114723 NPI number — COUNTY OF MARICOPA - MARICOPA COUNTY SCHOOL DIST 24

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MARICOPA - MARICOPA COUNTY SCHOOL DIST 24
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215114723
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
308 N. MARTIN AVENUE
Provider Second Line Business Mailing Address:
P O BOX V
Provider Business Mailing Address City Name:
GILA BEND
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85337-0420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-683-2225
Provider Business Mailing Address Fax Number:
928-683-2671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
308 N. MARTIN AVE
Provider Second Line Business Practice Location Address:
BOX V
Provider Business Practice Location Address City Name:
GILA BEND
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85337-0420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-683-2225
Provider Business Practice Location Address Fax Number:
928-683-2671
Provider Enumeration Date:
01/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYONS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
DIRECTOR SPECIAL EDUCATION
Authorized Official Telephone Number:
928-683-2225

Provider Taxonomy Codes

  • Taxonomy code: 251300000X , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 588717 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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