Provider Demographics
NPI:1487939005
Name:NORTH LAKES CHARTER ACADEMY
Entity type:Organization
Organization Name:NORTH LAKES CHARTER ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-982-2773
Mailing Address - Street 1:255 7TH AVE NW STE B
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-1177
Mailing Address - Country:US
Mailing Address - Phone:651-982-2773
Mailing Address - Fax:651-464-6409
Practice Address - Street 1:255 7TH AVE NW STE B
Practice Address - Street 2:
Practice Address - City:FOREST LAKE
Practice Address - State:MN
Practice Address - Zip Code:55025-1177
Practice Address - Country:US
Practice Address - Phone:651-982-2773
Practice Address - Fax:651-464-6409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)