Provider Demographics
NPI:1548481658
Name:UPHAMS CORNER CHARTER SCHOOL
Entity type:Organization
Organization Name:UPHAMS CORNER CHARTER SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:MARLENE
Authorized Official - Last Name:MARK-BELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-268-4695
Mailing Address - Street 1:7 ELKINS ST.
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02127
Mailing Address - Country:US
Mailing Address - Phone:617-268-4695
Mailing Address - Fax:617-268-5604
Practice Address - Street 1:7 ELKINS ST.
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SOUTH BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02127
Practice Address - Country:US
Practice Address - Phone:617-268-4695
Practice Address - Fax:617-268-5604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA195-58-53Medicaid