Provider Demographics
NPI:1770220162
Name:CIVICA CAREER AND COLLEGIATE ACADEMY
Entity Type:Organization
Organization Name:CIVICA CAREER AND COLLEGIATE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL PROJECTS
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:THIRIOT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-423-3348
Mailing Address - Street 1:1501 E CAREY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-5766
Mailing Address - Country:US
Mailing Address - Phone:702-452-9653
Mailing Address - Fax:
Practice Address - Street 1:1501 E CAREY AVE
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-5766
Practice Address - Country:US
Practice Address - Phone:702-452-9653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)