MEDICARE: ARIZONA AUTISM CHARTER SCHOOLS, INC.

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1376932103
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARIZONA AUTISM CHARTER SCHOOLS, INC.

Provider Business Mailing Address
First Line	:	4433 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4139
Country	:	US
Telephone Number	:	602-882-5544
Fax Number	:

Provider Business Practice Location Address
First Line	:	4433 N 7TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85014-4139
Country	:	US
Telephone Number	:	602-882-5544
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF SPECIAL EDUCATION
Name	:	MS. ROSETTA MARIE HICKS
Credential	:
Telephone Number	:	602-882-5544

Provider Enumeration Date	:	01/16/2015
Last Update Date	:	01/16/2015

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