MEDICARE: GLENDALE UNION HIGH SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)	RN188626	AZ

General Provider Information

NPI Number	:	1881086213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE UNION HIGH SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	6602 N 75TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3504
Country	:	US
Telephone Number	:	623-435-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	6602 N 75TH AVE
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85303-3504
Country	:	US
Telephone Number	:	623-435-6100
Fax Number	:

Authorized Official
Title or Position	:	MEDICAID COORDINATOR
Name	:	MS. JESSICA CONTRERAS
Credential	:
Telephone Number	:	635-435-6033

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	02/23/2015

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