Provider Demographics
NPI:1275757395
Name:STILLWATER SWEET GRASS SPECIAL EDUCATION COOPERATIVE
Entity Type:Organization
Organization Name:STILLWATER SWEET GRASS SPECIAL EDUCATION COOPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LANNY
Authorized Official - Last Name:STENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-322-5298
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:42 NORTH 4TH STREET
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0669
Mailing Address - Country:US
Mailing Address - Phone:406-322-5298
Mailing Address - Fax:406-322-4506
Practice Address - Street 1:42 NORTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-0669
Practice Address - Country:US
Practice Address - Phone:406-322-5298
Practice Address - Fax:406-322-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9704251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0161772Medicaid