Provider Demographics
NPI:1952572638
Name:UNIVERSITY ACADEMY CHARTER HIGH SCHOOL
Entity Type:Organization
Organization Name:UNIVERSITY ACADEMY CHARTER HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEMI COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:LENNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-200-3200
Mailing Address - Street 1:275 W SIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07305-1130
Mailing Address - Country:US
Mailing Address - Phone:201-200-3200
Mailing Address - Fax:201-200-3262
Practice Address - Street 1:275 W SIDE AVE
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07305-1130
Practice Address - Country:US
Practice Address - Phone:201-200-3200
Practice Address - Fax:201-200-3262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0119997Medicaid