Provider Demographics
NPI:1649445909
Name:PLEASANTECH ACADEMY CHARTER SCHOOL
Entity type:Organization
Organization Name:PLEASANTECH ACADEMY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARMETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG-VERNON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:609-383-1717
Mailing Address - Street 1:700 BLACK HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08330
Mailing Address - Country:US
Mailing Address - Phone:609-383-1717
Mailing Address - Fax:
Practice Address - Street 1:700 BLACK HORSE PIKE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08330
Practice Address - Country:US
Practice Address - Phone:609-383-1717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ01-47-427Medicaid