Provider Demographics
NPI:1346657566
Name:BASS LAKE JOINT UNION ESD
Entity Type:Organization
Organization Name:BASS LAKE JOINT UNION ESD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-642-1565
Mailing Address - Street 1:40096 INDIAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:OAKHURST
Mailing Address - State:CA
Mailing Address - Zip Code:93644-8729
Mailing Address - Country:US
Mailing Address - Phone:599-642-1555
Mailing Address - Fax:559-642-1556
Practice Address - Street 1:40096 INDIAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:CA
Practice Address - Zip Code:93644-8729
Practice Address - Country:US
Practice Address - Phone:599-642-1555
Practice Address - Fax:559-642-1556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-21
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS2065185Medicaid