Provider Demographics
NPI:1750946828
Name:LEARNING VILLAGE ACADEMY LLC
Entity type:Organization
Organization Name:LEARNING VILLAGE ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TYSHEIKA
Authorized Official - Middle Name:SANTORIA
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-309-7293
Mailing Address - Street 1:711 SAWYERS MILL RD APT 307
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1849
Mailing Address - Country:US
Mailing Address - Phone:843-309-7293
Mailing Address - Fax:
Practice Address - Street 1:711 SAWYERS MILL RD APT 307
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-1849
Practice Address - Country:US
Practice Address - Phone:843-309-7293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-04
Last Update Date:2019-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1538567888Medicaid