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General NPI Number Information
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NPI Number | 1194881565
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Entity Type | Organization
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Legal Business Name | CENTRAL REGION EDUCATIONAL COOPERATIVE
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5321 MENAUL BLVD NE STE A
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-3127
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Country | US
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Telephone | 505-889-3412
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Fax | 505-889-3422
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Provider Business Mailing Address
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Address Line | PO BOX 37440
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City | ALBUQUERQUE
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State | NM
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Zip | 87176
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Country | US
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Telephone | 505-889-3412
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Fax | 505-889-3422
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NINA TAFOYA
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Credential | NONE
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Telephone | 505-889-3412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 99472279
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License Number State | NM
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