Provider Demographics
NPI:1275349151
Name:PINECREST ACADEMY OF LEWISTON INC.
Entity type:Organization
Organization Name:PINECREST ACADEMY OF LEWISTON INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-717-3855
Mailing Address - Street 1:1212 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-2584
Mailing Address - Country:US
Mailing Address - Phone:208-717-3855
Mailing Address - Fax:208-717-9475
Practice Address - Street 1:1212 9TH AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-2584
Practice Address - Country:US
Practice Address - Phone:208-717-3855
Practice Address - Fax:208-717-9475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-05
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)