Healthcare Provider Details

I. General information

NPI: 1659292886
Provider Name (Legal Business Name): GOLD RUSH HOME-STUDY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16331 HIDDEN VALLEY RD
SONORA CA
95370-7926
US

IV. Provider business mailing address

16331 HIDDEN VALLEY RD
SONORA CA
95370-7926
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-9781
  • Fax:
Mailing address:
  • Phone: 209-532-9781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name: LETHA ROLLINSON
Title or Position: ASSOCIATE DIRECTOR/CBO
Credential:
Phone: 209-532-9781