Provider Demographics
NPI:1295290385
Name:AZALEA ACADEMY FOR EXCEPTIONAL ADULTS
Entity type:Organization
Organization Name:AZALEA ACADEMY FOR EXCEPTIONAL ADULTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAUNDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-520-4229
Mailing Address - Street 1:1506 S CHILTON AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-2909
Mailing Address - Country:US
Mailing Address - Phone:903-520-4229
Mailing Address - Fax:
Practice Address - Street 1:230 W RUSK ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1651
Practice Address - Country:US
Practice Address - Phone:903-520-4229
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services