Provider Demographics
NPI:1598940314
Name:BEAVER AREA ACADEMIC CHARTER SCHOOL
Entity Type:Organization
Organization Name:BEAVER AREA ACADEMIC CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CAO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:JR
Authorized Official - Credentials:EDD
Authorized Official - Phone:724-774-4010
Mailing Address - Street 1:855 SECOND ST.
Mailing Address - Street 2:C/O BEAVER AREA SD
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-2692
Mailing Address - Country:US
Mailing Address - Phone:724-774-4010
Mailing Address - Fax:724-774-8770
Practice Address - Street 1:855 SECOND ST.
Practice Address - Street 2:C/O BEAVER AREA SD
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2692
Practice Address - Country:US
Practice Address - Phone:724-774-4010
Practice Address - Fax:724-774-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1020091510001Medicaid