Healthcare Provider Details

I. General information

NPI: 1770078396
Provider Name (Legal Business Name): ACADEMY INDEPENDENT SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 E MAIN ST
LITTLE RIVER ACADEMY TX
76554-2604
US

IV. Provider business mailing address

704 E MAIN ST
LITTLE RIVER ACADEMY TX
76554-2604
US

V. Phone/Fax

Practice location:
  • Phone: 254-527-3340
  • 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

VIII. Authorized Official

Name: MR. KEVIN SPRINKLES
Title or Position: SUPERINTENDENT
Credential:
Phone: 254-982-4304