Provider Demographics
NPI:1871306761
Name:POLARIS ACADEMY LLC
Entity type:Organization
Organization Name:POLARIS ACADEMY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF BEHAVIOR SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUPI
Authorized Official - Suffix:
Authorized Official - Credentials:MS, BCBA-LBA
Authorized Official - Phone:480-903-1710
Mailing Address - Street 1:2913 N POWER RD STE 108
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1742
Mailing Address - Country:US
Mailing Address - Phone:480-903-1710
Mailing Address - Fax:
Practice Address - Street 1:1440 S CLEARVIEW AVE
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3380
Practice Address - Country:US
Practice Address - Phone:480-903-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency