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General NPI Number Information
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NPI Number | 1659517829
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Entity Type | Organization
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Legal Business Name | EAGLE ADVANTAGE ACADEMY, INC.
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 4011 JOSEPH HARDIN DR STE F
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City | DALLAS
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State | TX
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Zip | 75236-1507
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Country | US
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Telephone | 214-276-5846
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Fax | 214-467-4499
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Provider Business Mailing Address
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Address Line | 4011 JOSEPH HARDIN DR STE F
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City | DALLAS
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State | TX
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Zip | 75236-1507
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Country | US
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Telephone | 214-276-5846
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Fax | 214-467-4499
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Authorized Official
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Title or Position | CEO/SUPERINDENTANT
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Name | DR. ALLEN BECK
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Credential | PHD
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Telephone | 214-276-5800
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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 | 057806
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License Number State | TX
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