Provider Demographics
NPI:1043306491
Name:EARLY INTERVENTION EARLY CHILDHOOD SPECIAL EDUCATION
Entity Type:Organization
Organization Name:EARLY INTERVENTION EARLY CHILDHOOD SPECIAL EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:RAINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-266-3982
Mailing Address - Street 1:1350 TEAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:COOS BAY
Mailing Address - State:OR
Mailing Address - Zip Code:97420
Mailing Address - Country:US
Mailing Address - Phone:541-266-3982
Mailing Address - Fax:541-269-4536
Practice Address - Street 1:1350 TEAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:COOS BAY
Practice Address - State:OR
Practice Address - Zip Code:97420
Practice Address - Country:US
Practice Address - Phone:541-266-3982
Practice Address - Fax:541-269-4536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR132709Medicaid