Provider Demographics
NPI:1326262759
Name:LAGUNA DEPARTMENT OF EDUCATION
Entity Type:Organization
Organization Name:LAGUNA DEPARTMENT OF EDUCATION
Other - Org Name:LAGUANA DEPARTMENT OF EDUCATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-552-9200
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87026
Mailing Address - Country:US
Mailing Address - Phone:505-552-6008
Mailing Address - Fax:505-552-6398
Practice Address - Street 1:I-40 WEST, EXIT 114
Practice Address - Street 2:
Practice Address - City:LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87026
Practice Address - Country:US
Practice Address - Phone:505-552-9200
Practice Address - Fax:505-552-7294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR5884Medicaid