Provider Demographics
NPI:1891917753
Name:WESTSIDE UNION ELEMENTARY SCHOOL DISTRICT
Entity Type:Organization
Organization Name:WESTSIDE UNION ELEMENTARY SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR, EDUCATIONAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:MARGUERITE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-722-0716
Mailing Address - Street 1:41914 50TH ST W
Mailing Address - Street 2:STUDENT SUPPORT SERVICES
Mailing Address - City:QUARTZ HILL
Mailing Address - State:CA
Mailing Address - Zip Code:93536-2963
Mailing Address - Country:US
Mailing Address - Phone:661-722-0716
Mailing Address - Fax:661-722-1046
Practice Address - Street 1:41914 50TH ST W
Practice Address - Street 2:STUDENT SUPPORT SERVICES
Practice Address - City:QUARTZ HILL
Practice Address - State:CA
Practice Address - Zip Code:93536-2963
Practice Address - Country:US
Practice Address - Phone:661-722-0716
Practice Address - Fax:661-722-1046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
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
CASS1965102Medicaid