Provider Demographics
NPI:1528451465
Name:PINE FOREST EDUCATION ASSOCIATION, INC
Entity type:Organization
Organization Name:PINE FOREST EDUCATION ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:A
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:M ED
Authorized Official - Phone:928-214-6051
Mailing Address - Street 1:1120 W KAIBAB LN
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-6217
Mailing Address - Country:US
Mailing Address - Phone:928-214-6051
Mailing Address - Fax:
Practice Address - Street 1:1120 W KAIBAB LN
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-6217
Practice Address - Country:US
Practice Address - Phone:928-214-6051
Practice Address - Fax:928-779-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-17
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)