Provider Demographics
NPI:1629453535
Name:KIPP DUBOIS CHARTER SCHOOL
Entity Type:Organization
Organization Name:KIPP DUBOIS CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:BASS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-249-6089
Mailing Address - Street 1:5900 BALTIMORE AVE RM 206
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19143-3129
Mailing Address - Country:US
Mailing Address - Phone:215-307-3465
Mailing Address - Fax:215-307-3271
Practice Address - Street 1:5070 PARKSIDE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19131-4747
Practice Address - Country:US
Practice Address - Phone:215-307-3465
Practice Address - Fax:215-307-3271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-22
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)