Healthcare Provider Details

I. General information

NPI: 1437970613
Provider Name (Legal Business Name): EDNOVATE CHARTER SCHOOLS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 S VERMONT AVE
LOS ANGELES CA
90037-1916
US

IV. Provider business mailing address

3939 S VERMONT AVE
LOS ANGELES CA
90037-1916
US

V. Phone/Fax

Practice location:
  • Phone: 213-454-0599
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDRA HOUSTON
Title or Position: HEAD OF NURSING OPERATIONS
Credential: RN
Phone: 213-454-0599