Provider Demographics
NPI:1174032338
Name:LEAD ACADEMY, INC.
Entity type:Organization
Organization Name:LEAD ACADEMY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:KIRBY
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:304-573-0661
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:
Mailing Address - City:MIDWAY
Mailing Address - State:WV
Mailing Address - Zip Code:25878-0280
Mailing Address - Country:US
Mailing Address - Phone:304-573-0661
Mailing Address - Fax:
Practice Address - Street 1:351 VALLEY VIEW ST
Practice Address - Street 2:
Practice Address - City:MIDWAY
Practice Address - State:WV
Practice Address - Zip Code:25878
Practice Address - Country:US
Practice Address - Phone:304-573-0661
Practice Address - Fax:304-573-0661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No347E00000XTransportation ServicesTransportation Broker