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General NPI Number Information
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NPI Number | 1003145277
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Entity Type | Organization
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Legal Business Name | LISA ACADEMY
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Dates
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Enumeration Date | 12/16/2009
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Last Update Date | 12/16/2009
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Provider Practice Location Address
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Address Line | 21 CORPORATE HILL DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4537
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Country | US
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Telephone | 501-227-4942
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Fax | 501-229-4952
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Provider Business Mailing Address
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Address Line | 21 CORPORATE HILL DR
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City | LITTLE ROCK
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State | AR
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Zip | 72205-4537
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Country | US
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Telephone | 501-227-4942
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Fax | 501-229-4952
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Authorized Official
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Title or Position | PRINCIPAL
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Name | MR. ALI GUMUS
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Credential |
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Telephone | 501-227-4942
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number | 6041700
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License Number State | AR
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