Provider Demographics
NPI:1912314956
Name:TAFT UNION HIGH SCHOOL
Entity Type:Organization
Organization Name:TAFT UNION HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-763-2316
Mailing Address - Street 1:701 WILDCAT WAY
Mailing Address - Street 2:
Mailing Address - City:TAFT
Mailing Address - State:CA
Mailing Address - Zip Code:93268-8013
Mailing Address - Country:US
Mailing Address - Phone:661-763-2315
Mailing Address - Fax:661-763-1445
Practice Address - Street 1:701 WILDCAT WAY
Practice Address - Street 2:
Practice Address - City:TAFT
Practice Address - State:CA
Practice Address - Zip Code:93268-8013
Practice Address - Country:US
Practice Address - Phone:661-763-2315
Practice Address - Fax:661-763-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-22
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1563818Medicaid