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General NPI Number Information
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NPI Number | 1700367778
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Entity Type | Organization
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Legal Business Name | NORTHEAST RANDOLPH CO. R-IV
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 08/27/2018
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Provider Practice Location Address
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Address Line | 301 W MARTIN ST
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City | CAIRO
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State | MO
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Zip | 65239-1006
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Country | US
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Telephone | 660-263-2788
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Fax |
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Provider Business Mailing Address
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Address Line | 301 W MARTIN ST
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City | CAIRO
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State | MO
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Zip | 65239-1006
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Country | US
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Telephone | 660-263-2788
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF SPECIAL EDUCATION
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Name | SHANNA WEBER
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Credential |
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Telephone | 660-263-2788
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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