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General NPI Number Information
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NPI Number | 1649830944
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Entity Type | Organization
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Legal Business Name | DEMOCRACY PREP AGASSI CAMPUS
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 1201 W LAKE MEAD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89106-2411
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Country | US
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Telephone | 702-316-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 W LAKE MEAD BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89106-2411
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SPECIAL EDUCATION
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Name | ELLIE M GROSE
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Credential |
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Telephone | 347-501-0187
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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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