Healthcare Provider Details

I. General information

NPI: 1942714753
Provider Name (Legal Business Name): NORTHEAST BOCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2017
Last Update Date: 12/01/2017
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: 970-521-2771
  • Fax: 970-774-6157
Mailing address:
  • Phone: 970-521-2771
  • Fax: 970-774-6157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAMARA DURBIN
Title or Position: SPECIAL EDUCATION DIRECTOR
Credential:
Phone: 970-521-2771