Provider Demographics
NPI:1356705776
Name:VILLAGE ACADEMY OF MARYLAND
Entity type:Organization
Organization Name:VILLAGE ACADEMY OF MARYLAND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:KUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-336-1994
Mailing Address - Street 1:8601 ASHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-3721
Mailing Address - Country:US
Mailing Address - Phone:301-336-1904
Mailing Address - Fax:301-336-1906
Practice Address - Street 1:8601 ASHWOOD DR
Practice Address - Street 2:
Practice Address - City:CAPITOL HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-3721
Practice Address - Country:US
Practice Address - Phone:301-336-1904
Practice Address - Fax:301-336-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)