Provider Demographics
NPI:1750502530
Name:EAST CHICAGO LIGHTHOUSE CHARTER SCHOOL
Entity Type:Organization
Organization Name:EAST CHICAGO LIGHTHOUSE CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JODI
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-626-0901
Mailing Address - Street 1:1661 WORCESTER RD STE 207
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5401
Mailing Address - Country:US
Mailing Address - Phone:508-626-0901
Mailing Address - Fax:
Practice Address - Street 1:725 CLARK RD
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46406-1822
Practice Address - Country:US
Practice Address - Phone:219-977-9583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)