Provider Demographics
NPI:1144367632
Name:CALAVERAS UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:CALAVERAS UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILLERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-754-2204
Mailing Address - Street 1:PO BOX 788
Mailing Address - Street 2:
Mailing Address - City:SAN ANDREAS
Mailing Address - State:CA
Mailing Address - Zip Code:95249-9001
Mailing Address - Country:US
Mailing Address - Phone:209-754-2204
Mailing Address - Fax:
Practice Address - Street 1:3304 HWY 12 BLDG B
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:209-754-2204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS0561564251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS0561564Medicaid