Provider Demographics
NPI:1396210761
Name:PHOENIX ACADEMY OF ART AND SCIENCE
Entity Type:Organization
Organization Name:PHOENIX ACADEMY OF ART AND SCIENCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KROHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:763-402-0061
Mailing Address - Street 1:38460 LINCOLN TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-5834
Mailing Address - Country:US
Mailing Address - Phone:763-402-0061
Mailing Address - Fax:
Practice Address - Street 1:38460 LINCOLN TRL STE 1
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-5834
Practice Address - Country:US
Practice Address - Phone:763-402-0061
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)