Provider Demographics
NPI:1578812822
Name:SAN JOSE CHARTER ACADEMY
Entity Type:Organization
Organization Name:SAN JOSE CHARTER ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS SERVICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-856-1693
Mailing Address - Street 1:2021 W ALWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3259
Mailing Address - Country:US
Mailing Address - Phone:626-856-1693
Mailing Address - Fax:626-480-7118
Practice Address - Street 1:2021 W ALWOOD ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3259
Practice Address - Country:US
Practice Address - Phone:626-856-1693
Practice Address - Fax:626-480-7118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS6023527OtherMEDI-CAL