Provider Demographics
NPI:1043992993
Name:NOTABLY GIFTED ARTS ACADEMY INC
Entity type:Organization
Organization Name:NOTABLY GIFTED ARTS ACADEMY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-985-3703
Mailing Address - Street 1:2800 E RIVER RD
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1538
Mailing Address - Country:US
Mailing Address - Phone:937-985-3703
Mailing Address - Fax:
Practice Address - Street 1:2800 E RIVER RD
Practice Address - Street 2:
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1538
Practice Address - Country:US
Practice Address - Phone:937-985-3703
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health