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General NPI Number Information
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NPI Number | 1235408329
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Entity Type | Organization
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Legal Business Name | EDVISIONS OFF CAMPUS HIGH SCHOOL
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Dates
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Enumeration Date | 12/20/2011
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Last Update Date | 12/20/2011
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Provider Practice Location Address
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Address Line | 501 MAIN ST
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City | HENDERSON
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State | MN
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Zip | 56044-7709
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Country | US
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Telephone | 800-617-7857
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Fax | 866-665-2752
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Provider Business Mailing Address
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Address Line | PO BOX 307 501 MAIN STREET
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City | HENDERSON
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State | MN
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Zip | 56044-0307
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Country | US
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Telephone | 800-617-7857
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Fax | 866-665-2752
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Authorized Official
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Title or Position | CO-DIRECTOR
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Name | REGINA DOBOSENSKI
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Credential |
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Telephone | 800-617-7857
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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 |
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License Number State |
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