Healthcare Provider Details

I. General information

NPI: 1881074235
Provider Name (Legal Business Name): HERITAGE COMMUNITY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1803 E USTICK RD
CALDWELL ID
83605-6607
US

IV. Provider business mailing address

1803 E USTICK RD
CALDWELL ID
83605-6607
US

V. Phone/Fax

Practice location:
  • Phone: 208-453-8070
  • Fax:
Mailing address:
  • Phone: 208-453-8070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: DEREK B LINDQUIST
Title or Position: VICE PRINCIPAL
Credential:
Phone: 208-453-8070