Provider Demographics
NPI:1487664702
Name:IOSCO REGIONAL EDUCATIONAL SERVICE AGENCY
Entity Type:Organization
Organization Name:IOSCO REGIONAL EDUCATIONAL SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:989-362-3006
Mailing Address - Street 1:27 N REMPERT RD
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9752
Mailing Address - Country:US
Mailing Address - Phone:989-362-3006
Mailing Address - Fax:989-362-9076
Practice Address - Street 1:27 N REMPERT RD
Practice Address - Street 2:
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9752
Practice Address - Country:US
Practice Address - Phone:989-362-3006
Practice Address - Fax:989-362-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3022404Medicaid