Provider Demographics
NPI:1134317928
Name:TOLBERT EDUCATIONAL SERVICES INC.
Entity Type:Organization
Organization Name:TOLBERT EDUCATIONAL SERVICES INC.
Other - Org Name:LEE A. TOLBERT COMMUNITY ACADEMY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROPER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:816-561-0114
Mailing Address - Street 1:3400 PASEO
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2429
Mailing Address - Country:US
Mailing Address - Phone:816-561-0114
Mailing Address - Fax:816-561-1015
Practice Address - Street 1:3400 PASEO
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2429
Practice Address - Country:US
Practice Address - Phone:816-561-0114
Practice Address - Fax:816-561-1015
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOLBERT EDUCATIONAL SERVICES INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-05
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO466191004Medicaid
MO486191000Medicaid
MO476191002Medicaid