Provider Demographics
NPI:1881239515
Name:SOUTHEAST ARKANSAS PREPARATORY HIGH SCHOOL
Entity type:Organization
Organization Name:SOUTHEAST ARKANSAS PREPARATORY HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEA
Authorized Official - Prefix:MS
Authorized Official - First Name:KINCYL
Authorized Official - Middle Name:NICHOL
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-850-7323
Mailing Address - Street 1:1501 W 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8323
Mailing Address - Country:US
Mailing Address - Phone:870-850-7323
Mailing Address - Fax:
Practice Address - Street 1:1501 W 73RD AVE
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-8323
Practice Address - Country:US
Practice Address - Phone:870-850-7323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)