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General NPI Number Information
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NPI Number | 1881579134
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Entity Type | Organization
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Legal Business Name | HERITAGE ACADEMY LAVEEN, INC.
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 4275 W BASELINE RD
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City | LAVEEN
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State | AZ
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Zip | 85339-1880
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Country | US
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Telephone | 602-290-8545
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Fax | 602-926-2656
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Provider Business Mailing Address
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Address Line | 43 E 1ST AVE
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City | MESA
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State | AZ
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Zip | 85210-1446
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Country | US
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Telephone | 480-461-4405
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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 | BRANDON BERNARD
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Credential |
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Telephone | 480-461-4425
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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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