Provider Demographics
NPI:1346451028
Name:WEST COUNTY CONSORTIUM
Entity Type:Organization
Organization Name:WEST COUNTY CONSORTIUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-824-6403
Mailing Address - Street 1:462 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3431
Mailing Address - Country:US
Mailing Address - Phone:707-829-6403
Mailing Address - Fax:
Practice Address - Street 1:462 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3431
Practice Address - Country:US
Practice Address - Phone:707-829-6403
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS4970607Medicaid