Provider Demographics
NPI:1235218983
Name:POUDRE SCHOOL DISTRICT R-1
Entity Type:Organization
Organization Name:POUDRE SCHOOL DISTRICT R-1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-490-3355
Mailing Address - Street 1:2407 LAPORTE AVE
Mailing Address - Street 2:ATTENTION CHIEF FINANCIAL OFFICER
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80521-2211
Mailing Address - Country:US
Mailing Address - Phone:970-490-3355
Mailing Address - Fax:970-490-3035
Practice Address - Street 1:2407 LAPORTE AVE
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80521-2211
Practice Address - Country:US
Practice Address - Phone:970-490-3355
Practice Address - Fax:970-490-3035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04444048Medicaid