Healthcare Provider Details

I. General information

NPI: 1043358278
Provider Name (Legal Business Name): NORTHEAST BOCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W POWELL ST
HAXTUN CO
80731-2654
US

IV. Provider business mailing address

PO BOX 98
HAXTUN CO
80731-0098
US

V. Phone/Fax

Practice location:
  • Phone: 970-774-6152
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: TAMARA DURBIN
Title or Position: SPED DIRECTOR
Credential:
Phone: 970-774-6152