Provider Demographics
NPI:1174684914
Name:ST. VRAIN VALLEY SCHOOL DISTRICT RE-1J
Entity Type:Organization
Organization Name:ST. VRAIN VALLEY SCHOOL DISTRICT RE-1J
Other - Org Name:BOULDER COUNTY SCHOOL DISTRICT RE-1J
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF STUDENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-772-7700
Mailing Address - Street 1:395 S PRATT PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6436
Mailing Address - Country:US
Mailing Address - Phone:303-772-7700
Mailing Address - Fax:303-651-3066
Practice Address - Street 1:395 S PRATT PKWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6436
Practice Address - Country:US
Practice Address - Phone:303-772-7700
Practice Address - Fax:303-651-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04444055Medicaid