Healthcare Provider Details

I. General information

NPI: 1740300441
Provider Name (Legal Business Name): OLFEN ISD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROUTE 1 CR 686
ROWENA TX
76875
US

IV. Provider business mailing address

3132 EXECUTIVE DR
SAN ANGELO TX
76904-6802
US

V. Phone/Fax

Practice location:
  • Phone: 325-442-4301
  • Fax: 325-442-2133
Mailing address:
  • Phone: 325-947-0939
  • Fax: 325-947-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number0649402
License Number StateTX

VIII. Authorized Official

Name: NINA L. REID
Title or Position: DIRECTOR
Credential:
Phone: 325-947-0939