Provider Demographics
NPI:1205183258
Name:EAST RANGE ACADEMY OF SCIENCE AND TECHNOLOGY
Entity Type:Organization
Organization Name:EAST RANGE ACADEMY OF SCIENCE AND TECHNOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:218-744-7965
Mailing Address - Street 1:2000 SIEGEL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVELETH
Mailing Address - State:MN
Mailing Address - Zip Code:55734-8642
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 SIEGEL BLVD
Practice Address - Street 2:
Practice Address - City:EVELETH
Practice Address - State:MN
Practice Address - Zip Code:55734-8642
Practice Address - Country:US
Practice Address - Phone:218-744-7965
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-09
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)