Provider Demographics
NPI:1376682237
Name:MODESTO CITY SCHOOLS
Entity type:Organization
Organization Name:MODESTO CITY SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE SUPERINTENDENT, STUDENT S
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-492-5113
Mailing Address - Street 1:1581 CUMMINS DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95358
Mailing Address - Country:US
Mailing Address - Phone:209-492-5113
Mailing Address - Fax:209-574-1541
Practice Address - Street 1:1581 CUMMINS DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95358
Practice Address - Country:US
Practice Address - Phone:209-492-5113
Practice Address - Fax:209-574-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS5071167Medicaid