Provider Demographics
NPI:1710427034
Name:PROVIDENT CHARTER SCHOOL
Entity Type:Organization
Organization Name:PROVIDENT CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-709-5160
Mailing Address - Street 1:1400 TROY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-5124
Mailing Address - Country:US
Mailing Address - Phone:412-709-5160
Mailing Address - Fax:412-206-9923
Practice Address - Street 1:1400 TROY HILL RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-5124
Practice Address - Country:US
Practice Address - Phone:412-709-5160
Practice Address - Fax:412-206-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-06
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)