Provider Demographics
NPI:1285771691
Name:TIMOTHY L. JOHNSON ACADEMY
Entity type:Organization
Organization Name:TIMOTHY L. JOHNSON ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL LEADER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLLIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-441-8727
Mailing Address - Street 1:7908 S ANTHONY BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-2504
Mailing Address - Country:US
Mailing Address - Phone:260-441-8727
Mailing Address - Fax:260-441-9357
Practice Address - Street 1:7908 S ANTHONY BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-2504
Practice Address - Country:US
Practice Address - Phone:260-441-8727
Practice Address - Fax:260-441-9357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN9350251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)