Provider Demographics
NPI:1194881565
Name:CENTRAL REGION EDUCATIONAL COOPERATIVE
Entity type:Organization
Organization Name:CENTRAL REGION EDUCATIONAL COOPERATIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NINA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAFOYA
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:505-889-3412
Mailing Address - Street 1:PO BOX 37440
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87176
Mailing Address - Country:US
Mailing Address - Phone:505-889-3412
Mailing Address - Fax:505-889-3422
Practice Address - Street 1:5321 MENAUL BLVD NE STE A
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3127
Practice Address - Country:US
Practice Address - Phone:505-889-3412
Practice Address - Fax:505-889-3422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99472279171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty