Provider Demographics
NPI:1891864153
Name:PIMA COUNTY AMPHITHEATER SCHOOLS
Entity Type:Organization
Organization Name:PIMA COUNTY AMPHITHEATER SCHOOLS
Other - Org Name:SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT DIRECTOR SPECIAL EDUCATIO
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:FENSTAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:520-696-5095
Mailing Address - Street 1:701 WEST WETMORE ROAD
Mailing Address - Street 2:ATTN STUDENT SERVICES
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-1547
Mailing Address - Country:US
Mailing Address - Phone:520-696-5095
Mailing Address - Fax:520-696-5067
Practice Address - Street 1:701 WEST WETMORE ROAD
Practice Address - Street 2:ATTN STUDENT SERVICES
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-1547
Practice Address - Country:US
Practice Address - Phone:520-696-5095
Practice Address - Fax:520-696-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCTDS100210000251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ541012Medicaid