Provider Demographics
NPI:1194553602
Name:PHOENIX ACADEMY CHARTER - LAWRENCE
Entity type:Organization
Organization Name:PHOENIX ACADEMY CHARTER - LAWRENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NETWORK CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-889-3100
Mailing Address - Street 1:174 BRUSH HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1204
Mailing Address - Country:US
Mailing Address - Phone:413-735-2238
Mailing Address - Fax:413-735-2270
Practice Address - Street 1:15 UNION ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1866
Practice Address - Country:US
Practice Address - Phone:413-735-2238
Practice Address - Fax:413-735-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)