Provider Demographics
NPI:1578794061
Name:BREA-OLINDA SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BREA-OLINDA SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-990-7800
Mailing Address - Street 1:1 CIVIC CENTER CIR
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5792
Mailing Address - Country:US
Mailing Address - Phone:714-990-7820
Mailing Address - Fax:714-529-2137
Practice Address - Street 1:1 CIVIC CENTER CIR
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5792
Practice Address - Country:US
Practice Address - Phone:714-990-7820
Practice Address - Fax:714-529-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3066449251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3066449Medicaid