Provider Demographics
NPI:1376081042
Name:RICHARD MILBURN ACADEMY
Entity Type:Organization
Organization Name:RICHARD MILBURN ACADEMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:ALETHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-307-8582
Mailing Address - Street 1:1263 TERMINAL LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MC QUEENEY
Mailing Address - State:TX
Mailing Address - Zip Code:78123-3341
Mailing Address - Country:US
Mailing Address - Phone:830-557-6181
Mailing Address - Fax:
Practice Address - Street 1:1263 TERMINAL LOOP RD
Practice Address - Street 2:
Practice Address - City:MC QUEENEY
Practice Address - State:TX
Practice Address - Zip Code:78123-3341
Practice Address - Country:US
Practice Address - Phone:830-557-6181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid