Healthcare Provider Details

I. General information

NPI: 1295649952
Provider Name (Legal Business Name): CREDO HIGH SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 VALLEY HOUSE DR STE 100
ROHNERT PARK CA
94928-4931
US

IV. Provider business mailing address

1300 VALLEY HOUSE DR STE 100
ROHNERT PARK CA
94928-4931
US

V. Phone/Fax

Practice location:
  • Phone: 707-794-6005
  • Fax:
Mailing address:
  • Phone:
  • 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: ANDREA AKMENKALNS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 707-794-6003