Provider Demographics
NPI:1831319805
Name:BENJAMIN BANNEKER CHARTER PUBLIC SCHOOL
Entity Type:Organization
Organization Name:BENJAMIN BANNEKER CHARTER PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMBARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-497-7771
Mailing Address - Street 1:21 NOTRE DAME AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2505
Mailing Address - Country:US
Mailing Address - Phone:617-497-7771
Mailing Address - Fax:617-497-4223
Practice Address - Street 1:21 NOTRE DAME AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2505
Practice Address - Country:US
Practice Address - Phone:617-497-7771
Practice Address - Fax:617-497-4223
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 Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1955985Medicaid