Provider Demographics
NPI:1811156375
Name:RIVERSIDE SCHOOL DISTRICT NO.
Entity type:Organization
Organization Name:RIVERSIDE SCHOOL DISTRICT NO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYROLL CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-477-8919
Mailing Address - Street 1:1414 S 51ST AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-8003
Mailing Address - Country:US
Mailing Address - Phone:602-477-8900
Mailing Address - Fax:602-272-8378
Practice Address - Street 1:1414 S 51ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-8003
Practice Address - Country:US
Practice Address - Phone:602-477-8900
Practice Address - Fax:602-272-8378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ084081Medicaid