1366732349 NPI number — HERITAGE PEAK CHARTER SCHOOL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366732349 NPI number — HERITAGE PEAK CHARTER SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE PEAK CHARTER SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366732349
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 MADISON AVE
Provider Second Line Business Mailing Address:
SUITE 59
Provider Business Mailing Address City Name:
NORTH HIGHLANDS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95660-5077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-992-9033
Provider Business Mailing Address Fax Number:
916-338-4770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3600 MADISON AVE
Provider Second Line Business Practice Location Address:
SUITE 59
Provider Business Practice Location Address City Name:
NORTH HIGHLANDS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95660-5077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-992-9033
Provider Business Practice Location Address Fax Number:
916-338-4770
Provider Enumeration Date:
04/12/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KEEFER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
866-992-9033

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 34765050108415 . This is a "CDS CODE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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