Provider Demographics
NPI:1174094601
Name:GATEWAY STEM ACADEMY
Entity type:Organization
Organization Name:GATEWAY STEM ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ABDIAZIZ
Authorized Official - Middle Name:S
Authorized Official - Last Name:FARAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-206-4050
Mailing Address - Street 1:12119 16TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55337-2982
Mailing Address - Country:US
Mailing Address - Phone:952-206-4050
Mailing Address - Fax:
Practice Address - Street 1:12119 16TH AVE S
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55337-2982
Practice Address - Country:US
Practice Address - Phone:952-206-4050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)