Provider Demographics
NPI:1184929747
Name:LAVEEN SCHOOL DISTRICT #59
Entity type:Organization
Organization Name:LAVEEN SCHOOL DISTRICT #59
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:CANISALES
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:602-237-9100
Mailing Address - Street 1:9401 S 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2710
Mailing Address - Country:US
Mailing Address - Phone:602-237-9100
Mailing Address - Fax:
Practice Address - Street 1:9401 S 51ST AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-2710
Practice Address - Country:US
Practice Address - Phone:602-237-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2011-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP0361573140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric