Provider Demographics
NPI:1629135397
Name:PLACERVILLE UESD
Entity Type:Organization
Organization Name:PLACERVILLE UESD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERIM SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:NORDQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-622-3370
Mailing Address - Street 1:2777 DEL MONTE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3811
Mailing Address - Country:US
Mailing Address - Phone:916-375-1707
Mailing Address - Fax:
Practice Address - Street 1:1032 THOMPSON WAY
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5713
Practice Address - Country:US
Practice Address - Phone:530-622-3370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
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
CA09-61952OtherMEDI-CAL