Healthcare Provider Details

I. General information

NPI: 1396655239
Provider Name (Legal Business Name): VILLAGE CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 PINER RD
SANTA ROSA CA
95401-4035
US

IV. Provider business mailing address

2590 PINER RD
SANTA ROSA CA
95401-4035
US

V. Phone/Fax

Practice location:
  • Phone: 707-524-2848
  • Fax:
Mailing address:
  • Phone: 707-524-2848
  • Fax:

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: EMMA KERFOOT
Title or Position: OFFICE MANAGER / CBO
Credential:
Phone: 707-524-2848