Provider Demographics
NPI:1437428588
Name:HERITAGE ACADEMY
Entity Type:Organization
Organization Name:HERITAGE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-922-9300
Mailing Address - Street 1:500 S LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:JEROME
Mailing Address - State:ID
Mailing Address - Zip Code:83338-3027
Mailing Address - Country:US
Mailing Address - Phone:208-595-1617
Mailing Address - Fax:208-595-1619
Practice Address - Street 1:500 S LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-3027
Practice Address - Country:US
Practice Address - Phone:208-595-1617
Practice Address - Fax:208-595-1619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)