Provider Demographics
NPI:1174650303
Name:WISE COUNTY SPECIAL EDUCATION COOPERATIVE
Entity Type:Organization
Organization Name:WISE COUNTY SPECIAL EDUCATION COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEIMS MEDICAID ESPED COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:ALTHIEA
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-683-8361
Mailing Address - Street 1:2105 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:76426-2129
Mailing Address - Country:US
Mailing Address - Phone:940-683-8361
Mailing Address - Fax:940-683-1912
Practice Address - Street 1:2105 16TH ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:TX
Practice Address - Zip Code:76426-2129
Practice Address - Country:US
Practice Address - Phone:940-683-8361
Practice Address - Fax:940-683-1912
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)