Provider Demographics
NPI:1174654263
Name:LAKE TAHOE USD
Entity Type:Organization
Organization Name:LAKE TAHOE USD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-541-2850
Mailing Address - Street 1:1021 AL TAHOE BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-4502
Mailing Address - Country:US
Mailing Address - Phone:530-541-2850
Mailing Address - Fax:530-541-5930
Practice Address - Street 1:1021 AL TAHOE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-4502
Practice Address - Country:US
Practice Address - Phone:530-541-2850
Practice Address - Fax:530-541-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS0961903Medicaid