Provider Demographics
NPI:1225246820
Name:PHASE LL ACADEMY
Entity Type:Organization
Organization Name:PHASE LL ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:FENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-544-0261
Mailing Address - Street 1:3601 HAMILTON ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782-3946
Mailing Address - Country:US
Mailing Address - Phone:202-544-0261
Mailing Address - Fax:202-544-0262
Practice Address - Street 1:501 E ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-4236
Practice Address - Country:US
Practice Address - Phone:202-544-0261
Practice Address - Fax:202-544-0262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty