MEDICARE: C. M. GRANT LEADERSHIP 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	:	1891083697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	C. M. GRANT LEADERSHIP ACADEMY

Provider Business Mailing Address
First Line	:	2030 LEONARD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2105
Country	:	US
Telephone Number	:	614-252-2087
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 LEONARD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43219-2105
Country	:	US
Telephone Number	:	614-252-2087
Fax Number	:

Authorized Official
Title or Position	:	REGIONAL VICE PRESIDENT
Name	:	LAURA KUHLENBECK
Credential	:
Telephone Number	:	419-340-3630

Provider Enumeration Date	:	07/13/2011
Last Update Date	:	07/13/2011

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