=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801646625
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDUCATION FOR CHANGE CHARTER PUBLIC SCHOOLS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2024
-----------------------------------------------------
Last Update Date | 03/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 HEGENBERGER RD STE 705
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-568-7936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 HEGENBERGER RD STE 705
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94621-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-568-7936
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ACADEMIC OFFICER
-----------------------------------------------------
Name | DR. BRANDEE STEWART
-----------------------------------------------------
Credential | ED.D
-----------------------------------------------------
Telephone | 510-495-5455
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251300000X
-----------------------------------------------------
Taxonomy Name | Local Education Agency (LEA)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------