Provider Demographics
NPI:1265910657
Name:LAKE WALES CHARTER SCHOOLS INC
Entity type:Organization
Organization Name:LAKE WALES CHARTER SCHOOLS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALRICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMTIH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-215-8506
Mailing Address - Street 1:PO BOX 3309
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33859-3309
Mailing Address - Country:US
Mailing Address - Phone:863-215-8506
Mailing Address - Fax:863-679-6565
Practice Address - Street 1:130 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4166
Practice Address - Country:US
Practice Address - Phone:863-604-1615
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty