Provider Demographics
NPI:1518994698
Name:KALAMAZOO REGIONAL EDUCATIONAL SERVICE AGENCY
Entity Type:Organization
Organization Name:KALAMAZOO REGIONAL EDUCATIONAL SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-385-1536
Mailing Address - Street 1:1819 E MILHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49002-3035
Mailing Address - Country:US
Mailing Address - Phone:269-385-1536
Mailing Address - Fax:269-381-3523
Practice Address - Street 1:1819 E. MILHAM RD
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49002
Practice Address - Country:US
Practice Address - Phone:269-385-1536
Practice Address - Fax:269-381-3523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3019267Medicaid