Provider Demographics
NPI:1093805970
Name:SANGRE DE CRISTO SCHOOLS RE 22J
Entity Type:Organization
Organization Name:SANGRE DE CRISTO SCHOOLS RE 22J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-378-2310
Mailing Address - Street 1:5401 TERRY ST
Mailing Address - Street 2:
Mailing Address - City:MOSCA
Mailing Address - State:CO
Mailing Address - Zip Code:81146
Mailing Address - Country:US
Mailing Address - Phone:719-378-2310
Mailing Address - Fax:719-378-2327
Practice Address - Street 1:5401 TERRY ST
Practice Address - Street 2:
Practice Address - City:MOSCA
Practice Address - State:CO
Practice Address - Zip Code:81146
Practice Address - Country:US
Practice Address - Phone:719-378-2310
Practice Address - Fax:719-378-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58602381Medicaid