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General NPI Number Information
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NPI Number | 1346672169
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Entity Type | Organization
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Legal Business Name | MIDDLETOWN ELEMENTARY SCHOOL
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 20932 BIG CANYON RD
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City | MIDDLETOWN
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State | CA
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Zip | 95461-7721
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Country | US
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Telephone | 707-928-4100
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Fax | 707-987-4105
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Provider Business Mailing Address
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Address Line | 20932 BIG CANYON RD
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City | MIDDLETOWN
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State | CA
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Zip | 95461-7721
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Country | US
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Telephone | 707-987-4100
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Fax | 707-987-4105
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | DR. KORBY OLSON
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Credential | PHD
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Telephone | 707-987-4100
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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 |
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