Provider Demographics
NPI:1821130758
Name:WODEN ISD
Entity Type:Organization
Organization Name:WODEN ISD
Other - Org Name:NACOGDOCHES COUNTY SCHOOLS' CO-OP
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GERI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-564-5511
Mailing Address - Street 1:619 SE STALLINGS DR
Mailing Address - Street 2:P O BOX 630125
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-7208
Mailing Address - Country:US
Mailing Address - Phone:936-564-5511
Mailing Address - Fax:
Practice Address - Street 1:619 SE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75964-7208
Practice Address - Country:US
Practice Address - Phone:936-564-5511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065856902Medicaid