Provider Demographics
NPI:1043354012
Name:THREE RIVERS SPECIAL POPULATIONS COOP
Entity Type:Organization
Organization Name:THREE RIVERS SPECIAL POPULATIONS COOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHALEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-655-6768
Mailing Address - Street 1:8207 US HIGHWAY 87 N
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-7408
Mailing Address - Country:US
Mailing Address - Phone:325-655-6768
Mailing Address - Fax:325-655-6915
Practice Address - Street 1:8207 US HIGHWAY 87 N
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-7408
Practice Address - Country:US
Practice Address - Phone:325-655-6768
Practice Address - Fax:325-655-6915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)