Provider Demographics
NPI:1760535272
Name:STANISLAUS COUNTY OFFICE OF EDUCATION
Entity Type:Organization
Organization Name:STANISLAUS COUNTY OFFICE OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:209-238-1780
Mailing Address - Street 1:1100 H ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-2338
Mailing Address - Country:US
Mailing Address - Phone:209-238-1780
Mailing Address - Fax:209-238-4228
Practice Address - Street 1:1100 H ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-2338
Practice Address - Country:US
Practice Address - Phone:209-238-1780
Practice Address - Fax:209-238-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG76228251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1760535272Medicaid
CACHO1859Medicaid