Provider Demographics
NPI: | 1134490329 |
---|---|
Name: | MATCH COMMUNITY DAY CHARTER PUBLIC SCHOOL |
Entity Type: | Organization |
Organization Name: | MATCH COMMUNITY DAY CHARTER PUBLIC SCHOOL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | EXECUTIVE DIRECTOR |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | MIKE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | LARSSON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 781-956-3706 |
Mailing Address - Street 1: | 1001 COMMONWEALTH AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | BOSTON |
Mailing Address - State: | MA |
Mailing Address - Zip Code: | 02215-1308 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 617-232-0300 |
Mailing Address - Fax: | 617-232-2838 |
Practice Address - Street 1: | 215 FOREST HILLS ST |
Practice Address - Street 2: | |
Practice Address - City: | JAMAICA PLAIN |
Practice Address - State: | MA |
Practice Address - Zip Code: | 02130-3302 |
Practice Address - Country: | US |
Practice Address - Phone: | 857-203-9666 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2012-01-19 |
Last Update Date: | 2012-01-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MA | 04650105 | 251300000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251300000X | Agencies | Local Education Agency (LEA) |