Provider Demographics
NPI:1083835896
Name:CODMAN ACADEMY CHARTER SCHOOL
Entity Type:Organization
Organization Name:CODMAN ACADEMY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GOVINDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-287-0700
Mailing Address - Street 1:637 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-3510
Mailing Address - Country:US
Mailing Address - Phone:617-287-0700
Mailing Address - Fax:617-287-9064
Practice Address - Street 1:637 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:DORCHESTER CENTER
Practice Address - State:MA
Practice Address - Zip Code:02124-3510
Practice Address - Country:US
Practice Address - Phone:617-287-0700
Practice Address - Fax:617-287-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1956060Medicaid