Provider Demographics
NPI:1104014638
Name:MOUNTAIN HIGH SCHOOL
Entity Type:Organization
Organization Name:MOUNTAIN HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:FLO
Authorized Official - Middle Name:
Authorized Official - Last Name:MULLENDORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-336-0381
Mailing Address - Street 1:PO BOX 430
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-0430
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:23332 CRESTLINE RD.
Practice Address - Street 2:
Practice Address - City:CRESTLINE
Practice Address - State:CA
Practice Address - Zip Code:92325-0430
Practice Address - Country:US
Practice Address - Phone:909-336-0381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)