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General NPI Number Information
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NPI Number | 1295920478
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Entity Type | Organization
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Legal Business Name | MATTOLE UNIFIED SCHOOL DISTRICT
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 2120 CAMPTON RD SUITE H
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City | EUREKA
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State | CA
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Zip | 95503-8209
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Country | US
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Telephone | 707-476-8406
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Fax | 707-476-8069
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Provider Business Mailing Address
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Address Line | 29289 CHAMBERS RD.
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City | PETROLIA
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State | CA
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Zip | 95558
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Country | US
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Telephone | 707-629-3311
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Fax | 707-629-3575
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | RICHARD M GRAEY
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Credential |
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Telephone | 707-445-2660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State | CA
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