Provider Demographics
NPI:1477893204
Name:NORTH VALLEY CHARTER ACADEMY
Entity Type:Organization
Organization Name:NORTH VALLEY CHARTER ACADEMY
Other - Org Name:NORTH VALLEY MILITARY INSTITUTE
Other - Org Type:Other Name
Authorized Official - Title/Position:SPECIAL EDUCATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-368-1557
Mailing Address - Street 1:16651A RINALDI ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3632
Mailing Address - Country:US
Mailing Address - Phone:818-368-1557
Mailing Address - Fax:818-368-1935
Practice Address - Street 1:16651A RINALDI ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3632
Practice Address - Country:US
Practice Address - Phone:818-368-1557
Practice Address - Fax:818-368-1935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0540Medicaid
CA0540OtherMEDI-CAL