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Organization
ROOSEVELT ELEMENTARY SCHOOL DISTRICT #66
Active
Organization
ROOSEVELT ELEMENTARY SCHOOL DISTRICT #66
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. THERESA W HALE (MEDICAID COORDINATOR)
(602) 304-3117
Entity
Organization
Contact information
Practice address
6218 S 7TH ST, PHOENIX, AZ 85042-4211
(602) 243-4866
(602) 304-3132
Mailing address
6218 S 7TH ST, PHOENIX, AZ 85042-4211
(602) 243-4866
(602) 304-3132
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
554841
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
554841
—
AZ
Enumeration date
03/29/2007
Last updated
08/22/2020
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