Healthcare Provider Details

I. General information

NPI: 1184806317
Provider Name (Legal Business Name): SIERRA OAKS COMMUNITY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 W LINDA VISTA RD
ORACLE AZ
85623-6039
US

IV. Provider business mailing address

650 W LINDA VISTA RD
ORACLE AZ
85623-6039
US

V. Phone/Fax

Practice location:
  • Phone: 520-896-3100
  • Fax:
Mailing address:
  • Phone: 520-896-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251T00000X
TaxonomyPACE Provider Organization
License Number07-622471-V
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateAZ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KATHY MARGENAU MCANDREWS
Title or Position: SLP
Credential:
Phone: 520-896-3100