MEDICARE: REDWOOD COAST MONTESSORI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1366050213
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDWOOD COAST MONTESSORI

Provider Business Mailing Address
First Line	:	1611 PENINSULA DR
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-9658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 PENINSULA DR
Second Line	:
City	:	ARCATA
State	:	CA
Zip	:	95521-9658
Country	:	US
Telephone Number	:	707-630-5018
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	BRYAN LITTLE
Credential	:
Telephone Number	:	707-630-5018

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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Directions to “REDWOOD COAST MONTESSORI ” Practice Location

Language	Start Address	Practice Location

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