Provider Demographics
NPI:1629293931
Name:INNOVATION ACADEMY CHARTER SCHOOL
Entity Type:Organization
Organization Name:INNOVATION ACADEMY CHARTER SCHOOL
Other - Org Name:MURDOCH MIDDLE SCHOOL AT IACS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:SWEETNAM
Authorized Official - Last Name:LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:978-970-0100
Mailing Address - Street 1:40 BRICK KILN ROAD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:978-970-0100
Mailing Address - Fax:978-970-3522
Practice Address - Street 1:40 BRICK KILN ROAD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:978-970-0100
Practice Address - Fax:978-970-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1955845251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1955845Medicare ID - Type UnspecifiedSCHOOL PROVIDER NUMBER