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General NPI Number Information
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NPI Number | 1629453535
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Entity Type | Organization
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Legal Business Name | KIPP DUBOIS CHARTER SCHOOL
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 08/27/2015
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Provider Practice Location Address
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Address Line | 5070 PARKSIDE AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19131-4747
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Country | US
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Telephone | 215-307-3465
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Fax | 215-307-3271
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Provider Business Mailing Address
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Address Line | 5900 BALTIMORE AVE RM 206
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City | PHILADELPHIA
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State | PA
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Zip | 19143-3129
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Country | US
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Telephone | 215-307-3465
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Fax | 215-307-3271
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. AARON BASS
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Credential |
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Telephone | 267-249-6089
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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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