Provider Demographics
NPI:1871860270
Name:LIGHTHOUSE ACADEMY OF NATIONS HIGH SCHOOL
Entity Type:Organization
Organization Name:LIGHTHOUSE ACADEMY OF NATIONS HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-722-2555
Mailing Address - Street 1:2600 26TH AVE S
Mailing Address - Street 2:SUITE #100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4526
Mailing Address - Country:US
Mailing Address - Phone:612-722-2555
Mailing Address - Fax:612-729-2274
Practice Address - Street 1:2600 26TH AVE S
Practice Address - Street 2:SUITE #100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4526
Practice Address - Country:US
Practice Address - Phone:612-722-2555
Practice Address - Fax:612-729-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)