Provider Demographics
NPI:1831816917
Name:JOSEPH CHARTER SCHOOL
Entity type:Organization
Organization Name:JOSEPH CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:HOMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-263-1739
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:JOSEPH
Mailing Address - State:OR
Mailing Address - Zip Code:97846-2023
Mailing Address - Country:US
Mailing Address - Phone:541-432-1100
Mailing Address - Fax:
Practice Address - Street 1:400 E WILLIAMS AVE
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846-2023
Practice Address - Country:US
Practice Address - Phone:541-432-1100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-20
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR936000995Medicaid