Provider Demographics
NPI:1871860809
Name:MORELAND SCHOOL DISTRICT
Entity type:Organization
Organization Name:MORELAND SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST SUPERINTENDENT OF BUSINESS SER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:L
Authorized Official - Last Name:JELCICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-874-2951
Mailing Address - Street 1:4711 CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95130-1790
Mailing Address - Country:US
Mailing Address - Phone:408-874-2936
Mailing Address - Fax:408-874-2938
Practice Address - Street 1:4711 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95130-1790
Practice Address - Country:US
Practice Address - Phone:408-874-2936
Practice Address - Fax:408-874-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS4369575Medicaid