Provider Demographics
NPI:1043757800
Name:ACADEMY SCHOOL OF EXCELLENCE
Entity Type:Organization
Organization Name:ACADEMY SCHOOL OF EXCELLENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:MATHIS
Authorized Official - Suffix:
Authorized Official - Credentials:MA,
Authorized Official - Phone:954-478-5835
Mailing Address - Street 1:517 NW 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8851
Mailing Address - Country:US
Mailing Address - Phone:954-504-3407
Mailing Address - Fax:754-200-7485
Practice Address - Street 1:1161 SW 30TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2856
Practice Address - Country:US
Practice Address - Phone:954-504-3407
Practice Address - Fax:754-200-7485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)