Provider Demographics
NPI:1972871663
Name:GENERAL JOHN VESSEY JR. LEADERSHIP ACADEMY
Entity Type:Organization
Organization Name:GENERAL JOHN VESSEY JR. LEADERSHIP ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-776-8776
Mailing Address - Street 1:33 EAST WENTWORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:WEST ST. PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-3431
Mailing Address - Country:US
Mailing Address - Phone:651-776-8776
Mailing Address - Fax:
Practice Address - Street 1:33 EAST WENTWORTH AVENUE
Practice Address - Street 2:
Practice Address - City:WEST ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3431
Practice Address - Country:US
Practice Address - Phone:651-776-8776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6135621251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)