Provider Demographics
NPI:1215079215
Name:TOLLESON UNION HIGH SCHOOL DISTRICT
Entity type:Organization
Organization Name:TOLLESON UNION HIGH SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ASEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-478-4059
Mailing Address - Street 1:9419 W VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-2804
Mailing Address - Country:US
Mailing Address - Phone:623-478-4059
Mailing Address - Fax:623-478-4199
Practice Address - Street 1:9801 W VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:TOLLESON
Practice Address - State:AZ
Practice Address - Zip Code:85353-2804
Practice Address - Country:US
Practice Address - Phone:623-478-4059
Practice Address - Fax:623-478-4199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
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
AZ593592Medicaid