Provider Demographics
NPI:1669591798
Name:BERKELEY UNIFIED SCHOOL DISTRICT
Entity type:Organization
Organization Name:BERKELEY UNIFIED SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:HACKBARTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-644-8913
Mailing Address - Street 1:2134 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1109
Mailing Address - Country:US
Mailing Address - Phone:510-644-8913
Mailing Address - Fax:
Practice Address - Street 1:2134 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1109
Practice Address - Country:US
Practice Address - Phone:510-644-8913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASS0161143251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS0161143Medicaid