Provider Demographics
NPI:1689169047
Name:PERFORMANCE ACADEMY EASTLAND
Entity Type:Organization
Organization Name:PERFORMANCE ACADEMY EASTLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-905-0575
Mailing Address - Street 1:2 EASTON OVAL STE 525
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-7008
Mailing Address - Country:US
Mailing Address - Phone:614-905-0575
Mailing Address - Fax:
Practice Address - Street 1:2220 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43232-4304
Practice Address - Country:US
Practice Address - Phone:614-905-0575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)