=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396655239
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VILLAGE CHARTER SCHOOL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2026
-----------------------------------------------------
Last Update Date | 09/11/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2590 PINER RD
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-524-2848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2590 PINER RD
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95401-4035
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-524-2848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER / CBO
-----------------------------------------------------
Name | EMMA KERFOOT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 707-524-2848
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------