MEDICARE: ALTERNATIVE EDUCATION ACADEMY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1609286475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTERNATIVE EDUCATION ACADEMY

Provider Business Mailing Address
First Line	:	1550 OLD HENDERSON RD STE 110W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:	866-509-3099
Fax Number	:

Provider Business Practice Location Address
First Line	:	1550 OLD HENDERSON RD STE 110W
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43220-3626
Country	:	US
Telephone Number	:	866-509-3099
Fax Number	:

Authorized Official
Title or Position	:	FISCAL AGENT
Name	:	CHRISTOPHER DAVID MASSA
Credential	:
Telephone Number	:	330-515-0572

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	09/08/2025

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