Provider Demographics
NPI:1649496605
Name:KONOCTI UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:KONOCTI UNIFIED SCHOOL DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ALTIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-994-6475
Mailing Address - Street 1:PO BOX 5000
Mailing Address - Street 2:9430 LAKE STREET
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457-5000
Mailing Address - Country:US
Mailing Address - Phone:707-994-9475
Mailing Address - Fax:707-994-8469
Practice Address - Street 1:9430 LAKE STREET
Practice Address - Street 2:
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457-5000
Practice Address - Country:US
Practice Address - Phone:707-994-9475
Practice Address - Fax:707-994-8469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS1764022251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1764022OtherLEA