Provider Demographics
NPI:1659687648
Name:KOOTENAI VALLEY HEAD START
Entity Type:Organization
Organization Name:KOOTENAI VALLEY HEAD START
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH AND SPECIAL SERVICES COORDIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:TARA
Authorized Official - Last Name:GRANGER
Authorized Official - Suffix:
Authorized Official - Credentials:AAS
Authorized Official - Phone:406-293-4502
Mailing Address - Street 1:263 INDIAN HEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923
Mailing Address - Country:US
Mailing Address - Phone:406-293-4502
Mailing Address - Fax:406-293-9620
Practice Address - Street 1:263 INDIAN HEAD RD
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2982
Practice Address - Country:US
Practice Address - Phone:406-293-4502
Practice Address - Fax:406-293-9620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT08CH0113251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)