Provider Demographics
NPI:1659406494
Name:OLD ADOBE UNION ELEMENTARY SCHOOL DISTRICT
Entity type:Organization
Organization Name:OLD ADOBE UNION ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-765-4319
Mailing Address - Street 1:845 CRINELLA DR.
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-765-4321
Mailing Address - Fax:707-765-4385
Practice Address - Street 1:845 CRINELLA DR.
Practice Address - Street 2:
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-765-4321
Practice Address - Fax:707-765-4385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS4970847Medicaid