Provider Demographics
NPI:1629284500
Name:TRACY UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:TRACY UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERINTENDENT BUSINESS
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-830-3200
Mailing Address - Street 1:1975 W LOWELL AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-2238
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:209-830-3242
Practice Address - Street 1:1975 W LOWELL AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-2238
Practice Address - Country:US
Practice Address - Phone:209-830-3241
Practice Address - Fax:209-830-3242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS3968684Medicaid