=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558409466
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL SCHOOL DISTRICT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10601 CHURCH ST STE 112
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-980-3930
-----------------------------------------------------
Fax | 909-941-1732
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10601 CHURCH ST STE 112
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-6894
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-980-3930
-----------------------------------------------------
Fax | 909-941-1732
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR SPECIAL EDUCATION
-----------------------------------------------------
Name | MRS. KATHLEEN CALBERT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 909-980-3930
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------