Provider Demographics
NPI:1508083783
Name:EVERGREEN UNION ELEMENTARY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:EVERGREEN UNION ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HARLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:NORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-347-7955
Mailing Address - Street 1:19415 HOOKER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:96022-9649
Mailing Address - Country:US
Mailing Address - Phone:530-347-7955
Mailing Address - Fax:530-347-7954
Practice Address - Street 1:19415 HOOKER CREEK RD
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:CA
Practice Address - Zip Code:96022-9649
Practice Address - Country:US
Practice Address - Phone:530-347-7955
Practice Address - Fax:530-347-7954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS5271522251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)