Healthcare Provider Details

I. General information

NPI: 1447698139
Provider Name (Legal Business Name): BARACK OBAMA CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1726 E 117TH ST
LOS ANGELES CA
90059-2512
US

IV. Provider business mailing address

1726 E 117TH ST
LOS ANGELES CA
90059-2512
US

V. Phone/Fax

Practice location:
  • Phone: 818-456-4590
  • Fax:
Mailing address:
  • Phone: 818-456-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. JANET LOUISE NORA
Title or Position: SPED TEACHER
Credential:
Phone: 818-456-4590