MEDICARE: MATTOLE UNIFIED SCHOOL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		CA

General Provider Information

NPI Number	:	1295920478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTOLE UNIFIED SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	29289 CHAMBERS RD.
Second Line	:
City	:	PETROLIA
State	:	CA
Zip	:	95558
Country	:	US
Telephone Number	:	707-629-3311
Fax Number	:	707-629-3575

Provider Business Practice Location Address
First Line	:	2120 CAMPTON RD
Second Line	:	SUITE H
City	:	EUREKA
State	:	CA
Zip	:	95503-8209
Country	:	US
Telephone Number	:	707-476-8406
Fax Number	:	707-476-8069

Authorized Official
Title or Position	:	SUPERINTENDENT
Name	:	RICHARD M GRAEY
Credential	:
Telephone Number	:	707-445-2660

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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Directions to “MATTOLE UNIFIED SCHOOL DISTRICT ” Practice Location

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