Organization
MOTHER LODE UNION ELEMENTARY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. VANESSA CONSTANCIA (BUSINESS OFFCIAL)
(530) 622-6464
Entity
Organization
Contact information
Practice address
3783 FORNI RD, PLACERVILLE, CA 95667-6207
(530) 622-6464
Mailing address
3783 FORNI RD, PLACERVILLE, CA 95667-6207
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SS0961929
—
CA
Enumeration date
11/15/2008
Last updated
01/28/2010
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