Provider Demographics
NPI:1407265713
Name:PHOENIX UNION HIGH SCHOOL DISTRICT
Entity Type:Organization
Organization Name:PHOENIX UNION HIGH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIPS SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TARP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-764-1008
Mailing Address - Street 1:4502 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4502 N CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-1817
Practice Address - Country:US
Practice Address - Phone:602-764-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP048021251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care