Provider Demographics
NPI:1679692602
Name:CHRISTA MCAULIFFE REGIONAL CHARTER PUBLIC SCHOOL
Entity Type:Organization
Organization Name:CHRISTA MCAULIFFE REGIONAL CHARTER PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-879-9000
Mailing Address - Street 1:25 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-6702
Mailing Address - Country:US
Mailing Address - Phone:508-879-9000
Mailing Address - Fax:508-879-1066
Practice Address - Street 1:25 CLINTON ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6702
Practice Address - Country:US
Practice Address - Phone:508-879-9000
Practice Address - Fax:508-879-1066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0418251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1955730Medicaid