MEDICARE: LAVEEN SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	SLP5760	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073791463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAVEEN SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	9401 S 51ST AVE
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339-2710
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7275 WEST VINEYARD ROAD
Second Line	:
City	:	LAVEEN
State	:	AZ
Zip	:	85339
Country	:	US
Telephone Number	:	602-605-8540
Fax Number	:

Authorized Official
Title or Position	:	CONTACT PERSON
Name	:	VICKI CANISALES
Credential	:
Telephone Number	:	602-237-9100

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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Directions to “LAVEEN SCHOOL DISTRICT ” Practice Location

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