Provider Demographics
NPI:1861829731
Name:ODYSSEY CHARTER SCHOOL
Entity Type:Organization
Organization Name:ODYSSEY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-557-3627
Mailing Address - Street 1:1235 JONES ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83401-6044
Mailing Address - Country:US
Mailing Address - Phone:208-557-3627
Mailing Address - Fax:208-522-1289
Practice Address - Street 1:1235 JONES ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83401-6044
Practice Address - Country:US
Practice Address - Phone:208-557-3627
Practice Address - Fax:208-522-1289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1348251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)