Provider Demographics
NPI:1316302524
Name:MAIN STREET PREPARATORY ACADEMY
Entity type:Organization
Organization Name:MAIN STREET PREPARATORY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NIKITA
Authorized Official - Middle Name:
Authorized Official - Last Name:TIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-738-1925
Mailing Address - Street 1:388 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44311-1064
Mailing Address - Country:US
Mailing Address - Phone:234-738-1925
Mailing Address - Fax:330-812-3059
Practice Address - Street 1:388 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44311-1064
Practice Address - Country:US
Practice Address - Phone:234-738-1925
Practice Address - Fax:330-812-3059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)