Provider Demographics
NPI:1861045189
Name:BONNEVILLE ACADEMY
Entity Type:Organization
Organization Name:BONNEVILLE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-315-2080
Mailing Address - Street 1:800 W MONTAUK LN
Mailing Address - Street 2:
Mailing Address - City:STANSBURY PARK
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3385
Mailing Address - Country:US
Mailing Address - Phone:435-315-2080
Mailing Address - Fax:
Practice Address - Street 1:800 W MONTAUK LN
Practice Address - Street 2:
Practice Address - City:STANSBURY PARK
Practice Address - State:UT
Practice Address - Zip Code:84074-3385
Practice Address - Country:US
Practice Address - Phone:435-315-2080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-17
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)