Provider Demographics
NPI:1619360104
Name:PRIDE PREP SCHOOLS
Entity Type:Organization
Organization Name:PRIDE PREP SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:509-389-4848
Mailing Address - Street 1:811 E SPRAGUE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-2105
Mailing Address - Country:US
Mailing Address - Phone:509-389-4848
Mailing Address - Fax:
Practice Address - Street 1:811 E SPRAGUE AVE STE A
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-2105
Practice Address - Country:US
Practice Address - Phone:509-389-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-09
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA251300000XMedicaid