MEDICARE: CHICAGO PARK ELEMENTARY SCHOOL DISTRICT

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	:	1548149859
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHICAGO PARK ELEMENTARY SCHOOL DISTRICT

Provider Business Mailing Address
First Line	:	15725 MOUNT OLIVE RD
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-7906
Country	:	US
Telephone Number	:	530-346-2153
Fax Number	:

Provider Business Practice Location Address
First Line	:	15725 MOUNT OLIVE RD
Second Line	:
City	:	GRASS VALLEY
State	:	CA
Zip	:	95945-7906
Country	:	US
Telephone Number	:	530-346-2153
Fax Number	:

Authorized Official
Title or Position	:	SPECIAL EDUCATION DIRECTOR
Name	:	ROBIN JOHNSTON
Credential	:
Telephone Number	:	530-346-2153

Provider Enumeration Date	:	08/29/2025
Last Update Date	:	08/29/2025

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