Provider Demographics
NPI:1346960432
Name:THE REDWOOD ACADEMY
Entity Type:Organization
Organization Name:THE REDWOOD ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CO-FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVISSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-207-0645
Mailing Address - Street 1:2401 HAWTHORN PL
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8514
Mailing Address - Country:US
Mailing Address - Phone:317-450-0242
Mailing Address - Fax:
Practice Address - Street 1:2401 HAWTHORN PL
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8514
Practice Address - Country:US
Practice Address - Phone:317-450-0242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty