Healthcare Provider Details

I. General information

NPI: 1356628218
Provider Name (Legal Business Name): SUPERSTITION MOUNTAIN ELEMETARY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 11/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5002
US

IV. Provider business mailing address

550 S IRONWOOD DR
APACHE JUNCTION AZ
85120-5002
US

V. Phone/Fax

Practice location:
  • Phone: 480-677-7520
  • Fax:
Mailing address:
  • Phone: 480-677-7520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: INITIA MCCARTY
Title or Position: LPN
Credential:
Phone: 480-677-7520