Provider Demographics
NPI:1437351871
Name:IDAHO LEADERSHIP ACADEMY INC.
Entity Type:Organization
Organization Name:IDAHO LEADERSHIP ACADEMY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-684-9696
Mailing Address - Street 1:PO BOX 59
Mailing Address - Street 2:1506 W. 560 S.
Mailing Address - City:PINGREE
Mailing Address - State:ID
Mailing Address - Zip Code:83262-0059
Mailing Address - Country:US
Mailing Address - Phone:208-684-9696
Mailing Address - Fax:208-684-9404
Practice Address - Street 1:1506 W. 560 S.
Practice Address - Street 2:
Practice Address - City:PINGREE
Practice Address - State:ID
Practice Address - Zip Code:83262-0059
Practice Address - Country:US
Practice Address - Phone:208-684-9696
Practice Address - Fax:208-684-9404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)