Provider Demographics
NPI:1962686006
Name:MOUNTAIN EMPIRE USD
Entity Type:Organization
Organization Name:MOUNTAIN EMPIRE USD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JUDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-473-9022
Mailing Address - Street 1:3291 BUCKMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:PINE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91962-4003
Mailing Address - Country:US
Mailing Address - Phone:619-473-9022
Mailing Address - Fax:
Practice Address - Street 1:3291 BUCKMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:PINE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91962-4003
Practice Address - Country:US
Practice Address - Phone:619-473-9022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
SS3768213OtherMEDI-CAL