Provider Demographics
NPI:1114209228
Name:CHILDRESS ISD
Entity Type:Organization
Organization Name:CHILDRESS ISD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-937-2501
Mailing Address - Street 1:PO BOX 179
Mailing Address - Street 2:
Mailing Address - City:CHILDRESS
Mailing Address - State:TX
Mailing Address - Zip Code:79201-0179
Mailing Address - Country:US
Mailing Address - Phone:940-937-2501
Mailing Address - Fax:940-937-2938
Practice Address - Street 1:308 3RD ST NW
Practice Address - Street 2:
Practice Address - City:CHILDRESS
Practice Address - State:TX
Practice Address - Zip Code:79201-4542
Practice Address - Country:US
Practice Address - Phone:940-937-2501
Practice Address - Fax:940-937-2938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX251300000XMedicaid