Provider Demographics
NPI:1467578195
Name:PROSPECT HILL ACADEMY CHARTER SCHOOL
Entity Type:Organization
Organization Name:PROSPECT HILL ACADEMY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF SCHOOL
Authorized Official - Prefix:MR
Authorized Official - First Name:JED
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:LIPPARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-284-7800
Mailing Address - Street 1:15 WEBSTER AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 WEBSTER AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02143-3311
Practice Address - Country:US
Practice Address - Phone:617-284-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1956035OtherMASSHEALTH PROVIDER NUM.