Provider Demographics
NPI:1497205744
Name:BETTY SHABAZZ INTERANTIONAL CHARTER SCHOOL
Entity Type:Organization
Organization Name:BETTY SHABAZZ INTERANTIONAL CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:IRELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-651-2425
Mailing Address - Street 1:7823 S ELLIS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-3213
Mailing Address - Country:US
Mailing Address - Phone:773-651-1221
Mailing Address - Fax:773-651-1856
Practice Address - Street 1:7823 S ELLIS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-3213
Practice Address - Country:US
Practice Address - Phone:773-651-1221
Practice Address - Fax:773-651-1856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)