Provider Demographics
NPI:1699815456
Name:TEHAMA COUNTY DEPARTMENT OF EDUCATION
Entity Type:Organization
Organization Name:TEHAMA COUNTY DEPARTMENT OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUGLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-527-5811
Mailing Address - Street 1:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-0689
Mailing Address - Country:US
Mailing Address - Phone:530-527-5811
Mailing Address - Fax:530-529-4134
Practice Address - Street 1:1135 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-3125
Practice Address - Country:US
Practice Address - Phone:530-527-5811
Practice Address - Fax:530-529-4134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS5210520251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS5210520Medicaid