Provider Demographics
NPI:1013500099
Name:ATHLOS ACADEMY
Entity Type:Organization
Organization Name:ATHLOS ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL ED DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHYLAH
Authorized Official - Middle Name:
Authorized Official - Last Name:POIRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-438-4619
Mailing Address - Street 1:12309 MUSTANG TRAIL WAY
Mailing Address - Street 2:
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-5691
Mailing Address - Country:US
Mailing Address - Phone:801-438-4619
Mailing Address - Fax:
Practice Address - Street 1:12309 MUSTANG TRAIL WAY
Practice Address - Street 2:
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-5691
Practice Address - Country:US
Practice Address - Phone:180-143-8461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-19
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)