Provider Demographics
NPI:1235647496
Name:AMY L HOUSTON ACADEMY
Entity Type:Organization
Organization Name:AMY L HOUSTON ACADEMY
Other - Org Name:AMY L. HOUSTON ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-232-4230
Mailing Address - Street 1:20444 N 93RD AVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-5253
Mailing Address - Country:US
Mailing Address - Phone:602-232-4230
Mailing Address - Fax:
Practice Address - Street 1:20444 N 93RD AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5253
Practice Address - Country:US
Practice Address - Phone:602-232-4230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN204385163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========Medicaid