Provider Demographics
NPI:1508925306
Name:ALTAR VALLEY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:ALTAR VALLEY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-822-9201
Mailing Address - Street 1:10105 S. SASABE HWY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85736-1226
Mailing Address - Country:US
Mailing Address - Phone:520-822-9201
Mailing Address - Fax:520-822-9202
Practice Address - Street 1:10105 S SASABE HWY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85736-1226
Practice Address - Country:US
Practice Address - Phone:520-822-9201
Practice Address - Fax:520-822-9202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ585052Medicaid