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General NPI Number Information
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NPI Number | 1851102834
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Entity Type | Organization
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Legal Business Name | ST. BONAVENTURE ACADEMY
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Dates
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Enumeration Date | 01/17/2025
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 1 S MAIN ST
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-3225
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Country | US
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Telephone | 216-536-2633
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Fax |
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Provider Business Mailing Address
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Address Line | 1 S MAIN ST
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City | CHAGRIN FALLS
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State | OH
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Zip | 44022-3225
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Country | US
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Telephone | 216-536-2633
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | CARRIE GRACE
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Credential |
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Telephone | 216-536-2633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 146N00000X
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Taxonomy Name | Basic Emergency Medical Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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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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