Provider Demographics
NPI:1902848302
Name:LIVINGSTON EDUCATIONAL SERVICE AGENCY
Entity Type:Organization
Organization Name:LIVINGSTON EDUCATIONAL SERVICE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPT. FOR SPECIAL EDUCATION
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:T
Authorized Official - Last Name:MACLEOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-540-6803
Mailing Address - Street 1:1425 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-1916
Mailing Address - Country:US
Mailing Address - Phone:517-546-5550
Mailing Address - Fax:517-546-7047
Practice Address - Street 1:1425 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-1916
Practice Address - Country:US
Practice Address - Phone:517-546-5550
Practice Address - Fax:517-546-7047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2979850Medicaid