Provider Demographics
NPI:1174164974
Name:GORDON BERNELL CHARTER SCHOOL
Entity type:Organization
Organization Name:GORDON BERNELL CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:GENTRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-354-4881
Mailing Address - Street 1:3838 N CENTRAL AVE STE 1600
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1950
Mailing Address - Country:US
Mailing Address - Phone:800-354-4881
Mailing Address - Fax:602-926-2445
Practice Address - Street 1:2821 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1313
Practice Address - Country:US
Practice Address - Phone:505-916-8618
Practice Address - Fax:505-208-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)