Provider Demographics
NPI:1093938441
Name:ALHAMBRA SCHOOL DISTRICT #68
Entity Type:Organization
Organization Name:ALHAMBRA SCHOOL DISTRICT #68
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDENT BUSINESS SERVI
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:VIRGIL
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:602-336-2920
Mailing Address - Street 1:4510 N 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85019
Mailing Address - Country:US
Mailing Address - Phone:602-336-2920
Mailing Address - Fax:602-336-2270
Practice Address - Street 1:4510 N 37TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-3206
Practice Address - Country:US
Practice Address - Phone:602-336-2920
Practice Address - Fax:602-336-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ557986Medicaid