Provider Demographics
NPI:1205167491
Name:ENVISION ACADEMY
Entity type:Organization
Organization Name:ENVISION ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:GIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-451-2415
Mailing Address - Street 1:111 MYRTLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2525
Mailing Address - Country:US
Mailing Address - Phone:510-451-2415
Mailing Address - Fax:510-451-2768
Practice Address - Street 1:1515 WEBSTER STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3355
Practice Address - Country:US
Practice Address - Phone:510-596-8901
Practice Address - Fax:510-596-8905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-27
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)