Provider Demographics
NPI:1962562645
Name:EASTERN YELLOWSTONE SPECIAL SERVICES COOPERATIVE
Entity type:Organization
Organization Name:EASTERN YELLOWSTONE SPECIAL SERVICES COOPERATIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSTAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-200-7795
Mailing Address - Street 1:2016 GRAND AVE STE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2632
Mailing Address - Country:US
Mailing Address - Phone:406-200-7795
Mailing Address - Fax:406-200-7798
Practice Address - Street 1:2016 GRAND AVE STE C
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2632
Practice Address - Country:US
Practice Address - Phone:406-200-7795
Practice Address - Fax:406-200-7798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1962562645Medicaid
MT161863Medicaid