Healthcare Provider Details

I. General information

NPI: 1730966623
Provider Name (Legal Business Name): ENTERPRISE ELEMENTARY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2023
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MISTLETOE LN
REDDING CA
96002-0749
US

IV. Provider business mailing address

1155 MISTLETOE LN
REDDING CA
96002-0749
US

V. Phone/Fax

Practice location:
  • Phone: 530-224-4226
  • Fax: 530-224-4101
Mailing address:
  • Phone: 530-224-4226
  • Fax: 530-224-4101

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: KELLY PAGAN
Title or Position: DISTRICT NURSE
Credential: RN, MSN
Phone: 530-224-4226