Provider Demographics
NPI:1497879274
Name:FORT BRAGG UNIFIED
Entity Type:Organization
Organization Name:FORT BRAGG UNIFIED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-961-2850
Mailing Address - Street 1:312 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-4416
Mailing Address - Country:US
Mailing Address - Phone:707-961-3503
Mailing Address - Fax:707-964-5002
Practice Address - Street 1:312 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-4416
Practice Address - Country:US
Practice Address - Phone:707-961-3503
Practice Address - Fax:707-964-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS2365565Medicaid