Provider Demographics
NPI:1346360674
Name:CROWLEY'S RIDGE EDUCATION SERVICES CO-OP
Entity Type:Organization
Organization Name:CROWLEY'S RIDGE EDUCATION SERVICES CO-OP
Other - Org Name:EARLY CHILDHOOD SPECIAL EDUCATION PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:EARLY CHILDHOOD CO-ORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:KANDIE
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-578-0310
Mailing Address - Street 1:1606 PINE GROVE LANE
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:AR
Mailing Address - Zip Code:72432
Mailing Address - Country:US
Mailing Address - Phone:870-578-0323
Mailing Address - Fax:870-578-6005
Practice Address - Street 1:200 E SOUTH ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:AR
Practice Address - Zip Code:72432-1924
Practice Address - Country:US
Practice Address - Phone:870-578-5549
Practice Address - Fax:870-578-5610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251300000X
AR251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR122936743Medicaid