1053584128 NPI number — PERRIS UNION HIGH SCHOOL DISTRICT

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053584128 NPI number — PERRIS UNION HIGH SCHOOL DISTRICT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRIS UNION HIGH SCHOOL DISTRICT
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053584128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/03/2008
NPI Reactivation Date:
08/01/2008

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 E 4TH ST
Provider Second Line Business Mailing Address:
SPECIAL EDUCATION SERVICES
Provider Business Mailing Address City Name:
PERRIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92570-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-943-6531
Provider Business Mailing Address Fax Number:
951-943-6501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
755-B NORTH A STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PERRIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-943-6531
Provider Business Practice Location Address Fax Number:
951-943-6501
Provider Enumeration Date:
04/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAVAGE
Authorized Official First Name:
MARCY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR/SPECIAL EDUCATION
Authorized Official Telephone Number:
951-943-6531

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: SS3367207 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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