Provider Demographics
NPI:1124555982
Name:COSUMNES RIVER COLLEGE
Entity Type:Organization
Organization Name:COSUMNES RIVER COLLEGE
Other - Org Name:LOS RIOS COMMUNITY COLLEGE DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:CORY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-691-7252
Mailing Address - Street 1:8401 CENTER PKWY
Mailing Address - Street 2:VICE PRESIDENT STUDENT SERVICES
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-5704
Mailing Address - Country:US
Mailing Address - Phone:916-691-7487
Mailing Address - Fax:
Practice Address - Street 1:8401 CENTER PKWY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-5704
Practice Address - Country:US
Practice Address - Phone:916-691-7487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOS RIOS COMMUNITY COLLEGE DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)