Provider Demographics
NPI:1013045830
Name:COUNTIES OF ARCHULETA & HINSDALE DISTRICT 50 J F
Entity Type:Organization
Organization Name:COUNTIES OF ARCHULETA & HINSDALE DISTRICT 50 J F
Other - Org Name:PAGOSA SPRINGS SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT FINANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-264-2228
Mailing Address - Street 1:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:PAGOSA SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81147-1498
Mailing Address - Country:US
Mailing Address - Phone:970-264-2228
Mailing Address - Fax:
Practice Address - Street 1:309 LEWIS STREET
Practice Address - Street 2:
Practice Address - City:PAGOSA SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81147
Practice Address - Country:US
Practice Address - Phone:970-264-2228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49589032Medicaid