Provider Demographics
NPI:1629263272
Name:GALLATIN-MADISON SPECIAL EDUCATION CO-OPERATIVE
Entity Type:Organization
Organization Name:GALLATIN-MADISON SPECIAL EDUCATION CO-OPERATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAFERRIERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-388-6508
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-0162
Mailing Address - Country:US
Mailing Address - Phone:406-388-6508
Mailing Address - Fax:
Practice Address - Street 1:21000 FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8547
Practice Address - Country:US
Practice Address - Phone:406-388-6508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT165223Medicaid