Healthcare Provider Details

I. General information

NPI: 1720278799
Provider Name (Legal Business Name): PALISADES HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1507 GRANT ST
CALISTOGA CA
94515-1315
US

IV. Provider business mailing address

2310 1ST ST
NAPA CA
94559-2239
US

V. Phone/Fax

Practice location:
  • Phone: 707-942-5255
  • Fax:
Mailing address:
  • Phone: 707-255-1855
  • Fax: 707-255-5621

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: BRUCE LORING
Title or Position: DIRECTOR
Credential:
Phone: 707-942-5255