Provider Demographics
NPI:1710433974
Name:DYSART UNIFIED SCHOOL DISTRICT #89
Entity Type:Organization
Organization Name:DYSART UNIFIED SCHOOL DISTRICT #89
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH TECHNICIAN LPN
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LORI
Authorized Official - Last Name:ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:623-876-7000
Mailing Address - Street 1:15042 W SWEETWATER AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8164
Mailing Address - Country:US
Mailing Address - Phone:623-876-7000
Mailing Address - Fax:
Practice Address - Street 1:15042 W SWEETWATER AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85379-8164
Practice Address - Country:US
Practice Address - Phone:623-876-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP049018311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility