Provider Demographics
NPI:1093986515
Name:HIGH PLAINS REGIONAL EDUCATIONAL COOP
Entity Type:Organization
Organization Name:HIGH PLAINS REGIONAL EDUCATIONAL COOP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-445-7090
Mailing Address - Street 1:101 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-3803
Mailing Address - Country:US
Mailing Address - Phone:575-445-7090
Mailing Address - Fax:575-445-7663
Practice Address - Street 1:101 N 2ND ST
Practice Address - Street 2:
Practice Address - City:RATON
Practice Address - State:NM
Practice Address - Zip Code:87740-3803
Practice Address - Country:US
Practice Address - Phone:575-445-7090
Practice Address - Fax:575-445-7663
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HIGH PLAINS REGIONAL EDUCATIONAL COOP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-13
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)