Provider Demographics
NPI:1225135544
Name:HEAVENER PUBLIC SCHOOL (LEA)
Entity Type:Organization
Organization Name:HEAVENER PUBLIC SCHOOL (LEA)
Other - Org Name:LEFLORE COUNTY SPECIAL EDUCATION COOPERATIVE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-653-4936
Mailing Address - Street 1:WEST 2ND AND AVENUE C
Mailing Address - Street 2:P.O. BOX 698
Mailing Address - City:HEAVENER
Mailing Address - State:OK
Mailing Address - Zip Code:74937-0698
Mailing Address - Country:US
Mailing Address - Phone:918-653-4936
Mailing Address - Fax:
Practice Address - Street 1:WEST 2ND AND AVENUE C
Practice Address - Street 2:
Practice Address - City:HEAVENER
Practice Address - State:OK
Practice Address - Zip Code:74937-0698
Practice Address - Country:US
Practice Address - Phone:918-653-4936
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100680070AMedicaid