Provider Demographics
NPI:1316069388
Name:FORTUNA UNION HIGH SCHOOL
Entity type:Organization
Organization Name:FORTUNA UNION HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-725-4461
Mailing Address - Street 1:379 12TH ST
Mailing Address - Street 2:
Mailing Address - City:FORTUNA
Mailing Address - State:CA
Mailing Address - Zip Code:95540-2357
Mailing Address - Country:US
Mailing Address - Phone:707-725-4461
Mailing Address - Fax:707-725-5511
Practice Address - Street 1:379 12TH ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2357
Practice Address - Country:US
Practice Address - Phone:707-725-4461
Practice Address - Fax:707-725-5511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)