Provider Demographics
NPI:1235408329
Name:EDVISIONS OFF CAMPUS HIGH SCHOOL
Entity Type:Organization
Organization Name:EDVISIONS OFF CAMPUS HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBOSENSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-617-7857
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:501 MAIN STREET
Mailing Address - City:HENDERSON
Mailing Address - State:MN
Mailing Address - Zip Code:56044-0307
Mailing Address - Country:US
Mailing Address - Phone:800-617-7857
Mailing Address - Fax:866-665-2752
Practice Address - Street 1:501 MAIN ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:MN
Practice Address - Zip Code:56044-7709
Practice Address - Country:US
Practice Address - Phone:800-617-7857
Practice Address - Fax:866-665-2752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)