Healthcare Provider Details

I. General information

NPI: 1710433974
Provider Name (Legal Business Name): DYSART UNIFIED SCHOOL DISTRICT #89
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 08/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15042 W SWEETWATER AVE
SURPRISE AZ
85379-8164
US

IV. Provider business mailing address

15042 W SWEETWATER AVE
SURPRISE AZ
85379-8164
US

V. Phone/Fax

Practice location:
  • Phone: 623-876-7000
  • Fax:
Mailing address:
  • Phone: 623-876-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberLP049018
License Number StateAZ

VIII. Authorized Official

Name: MRS. HEATHER LORI ROBINS
Title or Position: HEALTH TECHNICIAN LPN
Credential: LPN
Phone: 623-876-7000