Provider Demographics
NPI:1497196513
Name:POTENTIAL DEVELOPMENT PROGRAM
Entity Type:Organization
Organization Name:POTENTIAL DEVELOPMENT PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:234-855-1278
Mailing Address - Street 1:POTENTIAL DEVELOPMENT PROGRAM
Mailing Address - Street 2:2405 MARKET ST
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44507
Mailing Address - Country:US
Mailing Address - Phone:330-746-7641
Mailing Address - Fax:330-746-4008
Practice Address - Street 1:POTENTIAL DEVELOPMENT PROGRAM
Practice Address - Street 2:2405 MARKET ST
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44507
Practice Address - Country:US
Practice Address - Phone:234-855-1278
Practice Address - Fax:330-746-4008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-17
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH132878251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)