Provider Demographics
NPI:1770858813
Name:EL COLEGIO VIA EDVISIONS COOPERATIVE
Entity Type:Organization
Organization Name:EL COLEGIO VIA EDVISIONS COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION TEACHER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-728-5728
Mailing Address - Street 1:4137 BLOOMINGTON AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3332
Mailing Address - Country:US
Mailing Address - Phone:612-728-5728
Mailing Address - Fax:
Practice Address - Street 1:4137 BLOOMINGTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3332
Practice Address - Country:US
Practice Address - Phone:612-728-5728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN450625251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)