Provider Demographics
NPI:1932430279
Name:OLD PUEBLO CHILDREN'S ACADEMY
Entity type:Organization
Organization Name:OLD PUEBLO CHILDREN'S ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:RICHELLE
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-296-1600
Mailing Address - Street 1:165 N SARNOFF DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85710-2933
Mailing Address - Country:US
Mailing Address - Phone:520-296-1600
Mailing Address - Fax:520-298-0558
Practice Address - Street 1:165 N SARNOFF DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2933
Practice Address - Country:US
Practice Address - Phone:520-296-1600
Practice Address - Fax:520-298-0558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)