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NPI Code Detail

MEDICARE: LAKE HAVASU UNIFIED SCHOOL DISTRICT #1

MEDICARE: LAKE HAVASU UNIFIED SCHOOL DISTRICT #1
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
1251300000XLocal Education Agency (LEA)AZ

General Provider Information

NPI Number : 1790879864
Entity Type Code : Organization
Provider Name (Legal Business Name) : LAKE HAVASU UNIFIED SCHOOL DISTRICT #1
Provider Business Mailing Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6935
Fax Number : 928-505-6991
Provider Business Practice Location Address
First Line : 2200 HAVASUPAI BLVD
Second Line :
City : LAKE HAVASU CITY
State : AZ
Zip : 86403-3122
Country : US
Telephone Number : 928-505-6935
Fax Number : 928-505-6991
Authorized Official
Title or Position : SPECIAL SERVICES DIRECTOR
Name : MRS. AGGIE WOLTER
Credential : PHD
Telephone Number : 928-505-6935
Provider Enumeration Date : 10/03/2006
Last Update Date : 08/22/2020

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Directions to “LAKE HAVASU UNIFIED SCHOOL DISTRICT #1 ” Practice Location

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