Provider Demographics
NPI:1497488514
Name:MOUNTAIN ISLAND CHARTER SCHOOL INC
Entity Type:Organization
Organization Name:MOUNTAIN ISLAND CHARTER SCHOOL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:BYRUM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-827-8840
Mailing Address - Street 1:13440 LUCIA RIVERBEND HWY
Mailing Address - Street 2:
Mailing Address - City:MT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-9766
Mailing Address - Country:US
Mailing Address - Phone:704-827-8840
Mailing Address - Fax:
Practice Address - Street 1:13440 LUCIA RIVERBEND HWY
Practice Address - Street 2:
Practice Address - City:MT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120-9766
Practice Address - Country:US
Practice Address - Phone:704-827-8840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)