Provider Demographics
NPI:1114180072
Name:WHITE PINE CHARTER SCHOOL
Entity Type:Organization
Organization Name:WHITE PINE CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-522-4432
Mailing Address - Street 1:2959 JOHN ADAM PARKWAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83406-4508
Mailing Address - Country:US
Mailing Address - Phone:208-522-4432
Mailing Address - Fax:208-522-4452
Practice Address - Street 1:2959 JOHN ADAM PARKWAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83406-4508
Practice Address - Country:US
Practice Address - Phone:208-522-4432
Practice Address - Fax:208-522-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)