Provider Demographics
NPI:1740378397
Name:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Entity type:Organization
Organization Name:SUNNYSIDE UNIFIED SCHOOL DISTRICT NO. 12
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT OF STUDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-545-2065
Mailing Address - Street 1:2238 E GINTER RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85706-5806
Mailing Address - Country:US
Mailing Address - Phone:520-545-2137
Mailing Address - Fax:520-545-2120
Practice Address - Street 1:2238 E GINTER RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85706-5806
Practice Address - Country:US
Practice Address - Phone:520-545-2137
Practice Address - Fax:520-545-2120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ546541Medicaid