Provider Demographics
NPI:1922295252
Name:IMAGINE MASTER ACADEMY
Entity Type:Organization
Organization Name:IMAGINE MASTER ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MR
Authorized Official - First Name:GUY
Authorized Official - Middle Name:
Authorized Official - Last Name:PLATTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-420-8395
Mailing Address - Street 1:2000 N WELLS ST
Mailing Address - Street 2:BUILDING 6
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46808-2495
Mailing Address - Country:US
Mailing Address - Phone:260-420-8395
Mailing Address - Fax:260-423-3508
Practice Address - Street 1:2000 N WELLS ST
Practice Address - Street 2:BUILDING 6
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46808-2495
Practice Address - Country:US
Practice Address - Phone:260-420-8395
Practice Address - Fax:260-423-3508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)