Provider Demographics
NPI:1770948614
Name:VENTURE ACADEMY
Entity type:Organization
Organization Name:VENTURE ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-468-4972
Mailing Address - Street 1:PO BOX 213030
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95213-9030
Mailing Address - Country:US
Mailing Address - Phone:209-468-5940
Mailing Address - Fax:
Practice Address - Street 1:2829 TRANSWORLD DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95206-3950
Practice Address - Country:US
Practice Address - Phone:209-468-5940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-18
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)