Healthcare Provider Details

I. General information

NPI: 1356209183
Provider Name (Legal Business Name): MARK TWAIN UNION ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2026
Last Update Date: 01/12/2026
Certification Date: 01/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

981 TUOLUMNE AVE
ANGELS CAMP CA
95222-9370
US

IV. Provider business mailing address

PO BOX 1359
ANGELS CAMP CA
95222-1359
US

V. Phone/Fax

Practice location:
  • Phone: 209-736-1859
  • Fax:
Mailing address:
  • Phone: 209-736-1859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JENINE FROST
Title or Position: CBO DIRECTOR OF BUSINESS SERVICES
Credential:
Phone: 209-736-1859