Provider Demographics
NPI:1891083697
Name:C. M. GRANT LEADERSHIP ACADEMY
Entity Type:Organization
Organization Name:C. M. GRANT LEADERSHIP ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUHLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-340-3630
Mailing Address - Street 1:2030 LEONARD AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-2105
Mailing Address - Country:US
Mailing Address - Phone:614-252-2087
Mailing Address - Fax:
Practice Address - Street 1:2030 LEONARD AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-2105
Practice Address - Country:US
Practice Address - Phone:614-252-2087
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)