Provider Demographics
NPI:1407400211
Name:EASTLAND PREPARATORY ACADEMY
Entity Type:Organization
Organization Name:EASTLAND PREPARATORY ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-515-0572
Mailing Address - Street 1:219 E MAPLE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-2586
Mailing Address - Country:US
Mailing Address - Phone:330-515-0572
Mailing Address - Fax:
Practice Address - Street 1:2741 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4904
Practice Address - Country:US
Practice Address - Phone:330-515-0572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)