Provider Demographics
NPI:1134490329
Name:MATCH COMMUNITY DAY CHARTER PUBLIC SCHOOL
Entity type:Organization
Organization Name:MATCH COMMUNITY DAY CHARTER PUBLIC SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-956-3706
Mailing Address - Street 1:1001 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1308
Mailing Address - Country:US
Mailing Address - Phone:617-232-0300
Mailing Address - Fax:617-232-2838
Practice Address - Street 1:215 FOREST HILLS ST
Practice Address - Street 2:
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-3302
Practice Address - Country:US
Practice Address - Phone:857-203-9666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA04650105251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)