Provider Demographics
NPI:1184229064
Name:OUR SACRED ACADEMY, INC.
Entity Type:Organization
Organization Name:OUR SACRED ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:YEPES
Authorized Official - Suffix:
Authorized Official - Credentials:MS GUIDANCE COUNSEL
Authorized Official - Phone:786-286-0667
Mailing Address - Street 1:2224 S JOG RD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33415-6101
Mailing Address - Country:US
Mailing Address - Phone:786-286-0667
Mailing Address - Fax:
Practice Address - Street 1:2224 S JOG RD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33415-6101
Practice Address - Country:US
Practice Address - Phone:786-286-0667
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities