Provider Demographics
NPI:1831467331
Name:EAGLE RIDGE ACADEMY
Entity Type:Organization
Organization Name:EAGLE RIDGE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:UDOMAH
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:952-746-7760
Mailing Address - Street 1:7255 FLYING CLOUD DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344
Mailing Address - Country:US
Mailing Address - Phone:952-746-7760
Mailing Address - Fax:
Practice Address - Street 1:7255 FLYING CLOUD DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344
Practice Address - Country:US
Practice Address - Phone:952-746-7760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)