Healthcare Provider Details

I. General information

NPI: 1265332068
Provider Name (Legal Business Name): UNION STREET CHARTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2026
Last Update Date: 11/06/2026
Certification Date: 11/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 UNION ST
ARCATA CA
95521-6429
US

IV. Provider business mailing address

470 UNION ST
ARCATA CA
95521-6429
US

V. Phone/Fax

Practice location:
  • Phone: 707-822-4845
  • Fax: 707-825-9025
Mailing address:
  • Phone: 707-822-4845
  • Fax: 707-825-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MS. REA ANNE ERICKSON
Title or Position: DIRECTOR
Credential:
Phone: 707-822-4845