Provider Demographics
NPI:1487792180
Name:OSBORN SCHOOL DISTRICT
Entity type:Organization
Organization Name:OSBORN SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNANY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-707-2007
Mailing Address - Street 1:1226 W OSBORN RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-3618
Mailing Address - Country:US
Mailing Address - Phone:602-707-2007
Mailing Address - Fax:602-707-2070
Practice Address - Street 1:1226 W. OSBORN ROAD
Practice Address - Street 2:
Practice Address - City:PHONIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-3618
Practice Address - Country:US
Practice Address - Phone:602-707-2007
Practice Address - Fax:602-707-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
AZ251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ552077Medicaid