Provider Demographics
NPI:1679827968
Name:MARTIN LUTHER KING, JR. CHARTER SCHOOL
Entity Type:Organization
Organization Name:MARTIN LUTHER KING, JR. CHARTER SCHOOL
Other - Org Name:MARTIN LUTHER KING, JR. CHARTER SCHOOL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:413-214-7806
Mailing Address - Street 1:285 DORSET ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2821
Mailing Address - Country:US
Mailing Address - Phone:413-214-7806
Mailing Address - Fax:413-214-7838
Practice Address - Street 1:174 BRUSH HILL AVE
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1204
Practice Address - Country:US
Practice Address - Phone:413-735-2237
Practice Address - Fax:413-735-2270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951297Medicaid