Healthcare Provider Details

I. General information

NPI: 1457575797
Provider Name (Legal Business Name): DOUGLAS UNIFIED SCHOOL DISTRICT #27
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1132 E 12TH ST
DOUGLAS AZ
85607-2337
US

IV. Provider business mailing address

1132 E 12TH ST
DOUGLAS AZ
85607-2337
US

V. Phone/Fax

Practice location:
  • Phone: 520-364-2447
  • Fax: 520-805-4175
Mailing address:
  • Phone: 520-364-2447
  • Fax: 520-805-4175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License NumberCTD 020227
License Number StateAZ

VIII. Authorized Official

Name: DR. ROSE HAMWAY
Title or Position: INT SPECIAL EDUCATION DIRECTOR
Credential: PHD
Phone: 520-364-2447