Provider Demographics
NPI:1831245802
Name:BUTTE GLENN COMMUNITY COLLEGE DISTRICT
Entity type:Organization
Organization Name:BUTTE GLENN COMMUNITY COLLEGE DISTRICT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF ADMINISTRATION
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SULESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-895-2353
Mailing Address - Street 1:3536 BUTTE CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95965-8399
Mailing Address - Country:US
Mailing Address - Phone:530-895-2441
Mailing Address - Fax:530-895-2846
Practice Address - Street 1:3536 BUTTE CAMPUS DRIVE
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95965-8399
Practice Address - Country:US
Practice Address - Phone:530-895-2441
Practice Address - Fax:530-895-2846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22866261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
A23274Medicare UPIN