Provider Demographics
NPI:1023221108
Name:WOODLAND PARK SCHOOL DISTRICT RE2
Entity Type:Organization
Organization Name:WOODLAND PARK SCHOOL DISTRICT RE2
Other - Org Name:COUNTY OF TELLER SCHOOL DISTRICT RE 2
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOFTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-290-6820
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:CO
Mailing Address - Zip Code:80866
Mailing Address - Country:US
Mailing Address - Phone:719-686-2018
Mailing Address - Fax:719-686-2019
Practice Address - Street 1:155 PANTHER WAY
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863
Practice Address - Country:US
Practice Address - Phone:719-686-2000
Practice Address - Fax:719-686-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO96724757Medicaid