1215913017 NPI number — LAWRENCE COUNTY COOPERATIVE SCHOOL, INC.

Table of content: (NPI 1215913017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215913017 NPI number — LAWRENCE COUNTY COOPERATIVE SCHOOL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAWRENCE COUNTY COOPERATIVE SCHOOL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215913017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTIA
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72457-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-886-7083
Provider Business Mailing Address Fax Number:
870-886-2611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 S. LAWRENCE EXT. STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTIA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72457-0016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-886-7083
Provider Business Practice Location Address Fax Number:
870-886-2611
Provider Enumeration Date:
12/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
LISA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
870-886-7083

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132375774 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121126732 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 146080778 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 103152724 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 125981767 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114248715 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 132620786 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 131867782 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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