Organization
THE ACADEMY AT ROOSEVELT CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD KENNETH LEVESQUE (SYSTEMS MANAGER)
(208) 922-3093
Entity
Organization
Contact information
Practice address
240 E MAPLE ST, POCATELLO, ID 83201-4647
(208) 232-1447
Mailing address
240 E MAPLE ST, POCATELLO, ID 83201-4647
(208) 232-1447
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8076220
—
ID
Enumeration date
05/01/2008
Last updated
05/01/2008
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