Healthcare Provider Details

I. General information

NPI: 1437538121
Provider Name (Legal Business Name): CALISTOGA JUNIOR SENIOR HIGH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2015
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 OAK ST
NAPA CA
94559-2337
US

IV. Provider business mailing address

1608 LAKE ST
CALISTOGA CA
94515-1359
US

V. Phone/Fax

Practice location:
  • Phone: 707-225-5185
  • Fax: 707-255-5621
Mailing address:
  • Phone: 707-255-1855
  • Fax: 707-255-5621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANA L GRIFFIN
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 707-224-8266