Healthcare Provider Details

I. General information

NPI: 1750487450
Provider Name (Legal Business Name): FLOWING WELLS UNIFIED SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 W PRINCE RD
TUCSON AZ
85705-3014
US

IV. Provider business mailing address

1450 W PRINCE RD
TUCSON AZ
85705-3014
US

V. Phone/Fax

Practice location:
  • Phone: 520-696-8836
  • Fax: 520-690-2405
Mailing address:
  • Phone: 520-696-8836
  • Fax: 520-690-2405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number554114
License Number StateAZ

VIII. Authorized Official

Name: RENE GROUND
Title or Position: DIRECTOR OF STUDENT SERVICES
Credential: ED.D.
Phone: 520-696-8836