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General NPI Number Information
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NPI Number | 1992312565
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Entity Type | Organization
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Legal Business Name | DORAL ACADEMY IDAHO
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Dates
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Enumeration Date | 09/28/2020
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Last Update Date | 09/28/2020
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Provider Practice Location Address
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Address Line | 2511 W CHERRY LN
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City | MERIDIAN
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State | ID
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Zip | 83642-1135
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Country | US
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Telephone | 208-901-8281
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Fax |
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Provider Business Mailing Address
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Address Line | 6630 SURREY ST
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City | LAS VEGAS
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State | NV
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Zip | 89119-3928
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Country | US
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Telephone | 702-431-6260
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | TREVOR GOODSELL
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Credential |
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Telephone | 702-431-6260
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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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