MEDICARE: WOODSON INSTITUTE FOR EXCELLENCE CHARTER SCHOOL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1164703344
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODSON INSTITUTE FOR EXCELLENCE CHARTER SCHOOL

Provider Business Mailing Address
First Line	:	1501 ALDRICH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3335
Country	:	US
Telephone Number	:	612-455-1611
Fax Number	:	612-455-1612

Provider Business Practice Location Address
First Line	:	1501 ALDRICH AVE N
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55411-3335
Country	:	US
Telephone Number	:	612-455-1611
Fax Number	:	612-455-1612

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. LA'TANYA WASHINGTON
Credential	:
Telephone Number	:	612-455-1611

Provider Enumeration Date	:	09/01/2011
Last Update Date	:	09/01/2011

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