Provider Demographics
NPI:1790801553
Name:BASSETT UNIFIED SCHOOL DISTRICT
Entity Type:Organization
Organization Name:BASSETT UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SUPERENTENDENT BUSINESS
Authorized Official - Prefix:MR
Authorized Official - First Name:JIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-931-3008
Mailing Address - Street 1:904 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-1615
Mailing Address - Country:US
Mailing Address - Phone:626-931-3053
Mailing Address - Fax:626-918-3195
Practice Address - Street 1:904 WILLOW AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91746-1615
Practice Address - Country:US
Practice Address - Phone:626-931-3053
Practice Address - Fax:626-918-3195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
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
CASS1964295Medicaid