Healthcare Provider Details

I. General information

NPI: 1740185933
Provider Name (Legal Business Name): JULIAN CHARTER SCHOOL (JCS-LIVE)
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 CAPE HORN
JULIAN CA
92036
US

IV. Provider business mailing address

PO BOX 2470
JULIAN CA
92036-2470
US

V. Phone/Fax

Practice location:
  • Phone: 760-765-5500
  • Fax:
Mailing address:
  • Phone: 760-765-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CLAIRE ROUSH
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 619-832-1220