Provider Demographics
NPI:1477670743
Name:ISAAC SCHOOL DISTRICT NO. 5
Entity Type:Organization
Organization Name:ISAAC SCHOOL DISTRICT NO. 5
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:MORALES
Authorized Official - Last Name:MENDOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-455-6729
Mailing Address - Street 1:3348 W MCDOWELL RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85009-2416
Mailing Address - Country:US
Mailing Address - Phone:602-455-6700
Mailing Address - Fax:602-455-6702
Practice Address - Street 1:3348 W MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85009-2416
Practice Address - Country:US
Practice Address - Phone:602-455-6700
Practice Address - Fax:602-455-6702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-026169251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ591611Medicaid