Healthcare Provider Details

I. General information

NPI: 1871991927
Provider Name (Legal Business Name): SHINING STARS MONTESSORI ACADEMY PUBLIC CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2014
Last Update Date: 12/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6015 CHILLUM PL NE
WASHINGTON DC
20011-1501
US

IV. Provider business mailing address

6015 CHILLUM PL NE
WASHINGTON DC
20011-1501
US

V. Phone/Fax

Practice location:
  • Phone: 202-723-1467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateDC

VIII. Authorized Official

Name: JARED WILLIAMS
Title or Position: SPECIAL EDUCATION COORDINATOR
Credential:
Phone: 202-577-1753