Provider Demographics
NPI:1376606889
Name:LAKE COUNTY SCHOOL DISTRICT R-1
Entity Type:Organization
Organization Name:LAKE COUNTY SCHOOL DISTRICT R-1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL NURSE/MCD COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-293-0975
Mailing Address - Street 1:328 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3547
Mailing Address - Country:US
Mailing Address - Phone:719-486-6810
Mailing Address - Fax:
Practice Address - Street 1:328 W 5TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3547
Practice Address - Country:US
Practice Address - Phone:719-486-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========Medicaid