Provider Demographics
NPI:1578383352
Name:KIPP VALIANT COMMUNITY PREP
Entity type:Organization
Organization Name:KIPP VALIANT COMMUNITY PREP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDI-CAL BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LINGSCHEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-992-0037
Mailing Address - Street 1:1000 BROADWAY STE 460
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4033
Mailing Address - Country:US
Mailing Address - Phone:510-465-5477
Mailing Address - Fax:
Practice Address - Street 1:1000 BROADWAY STE 460
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4033
Practice Address - Country:US
Practice Address - Phone:510-465-5477
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIPP BRIDGE CHARTER SCHOOL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)