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General NPI Number Information
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NPI Number | 1043181563
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Entity Type | Organization
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Legal Business Name | BLACK OAK MINE UNIFIED SCHOOL DISTRICT
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 6530 WENTWORTH SPRINGS RD
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City | GEORGETOWN
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State | CA
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Zip | 95634-9701
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Country | US
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Telephone | 530-333-8320
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Fax |
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Provider Business Mailing Address
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Address Line | 9080 COUNTRY RD
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City | GEORGETOWN
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State | CA
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Zip | 95634-9732
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Country | US
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Telephone | 530-903-9188
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Fax |
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Authorized Official
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Title or Position | WELLNESS COACH
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Name | CLORISA LYNN BLISH
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Credential | CWCII WELLNESS COACH
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Telephone | 530-903-9188
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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