Healthcare Provider Details

I. General information

NPI: 1740328780
Provider Name (Legal Business Name): AVONDALE ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 07/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W WESTERN AVE
AVONDALE AZ
85323-1848
US

IV. Provider business mailing address

235 W WESTERN AVE
AVONDALE AZ
85323-1848
US

V. Phone/Fax

Practice location:
  • Phone: 623-772-5028
  • Fax: 623-772-5090
Mailing address:
  • Phone: 623-772-5028
  • Fax: 623-772-5090

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: MR. PATRICK PERRYMAN
Title or Position: SPECIAL SERVICES DIRECTOR
Credential:
Phone: 623-772-5028