Provider Demographics
NPI:1902174568
Name:SOUTHSIDE FAMILY CHARTER SCHOOL
Entity Type:Organization
Organization Name:SOUTHSIDE FAMILY CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-872-8322
Mailing Address - Street 1:4500 CLINTON AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-5143
Mailing Address - Country:US
Mailing Address - Phone:612-872-8322
Mailing Address - Fax:612-872-0612
Practice Address - Street 1:4500 CLINTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55419-5143
Practice Address - Country:US
Practice Address - Phone:612-872-8322
Practice Address - Fax:612-872-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)