Provider Demographics
NPI:1376752675
Name:LAGUNA EARLY CHILDHOOD PROGRAM
Entity Type:Organization
Organization Name:LAGUNA EARLY CHILDHOOD PROGRAM
Other - Org Name:LAGUNA DIVISION OF EARLY CHILDHOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MASTERS EDUCATION
Authorized Official - Phone:505-552-6008
Mailing Address - Street 1:PO BOX 798
Mailing Address - Street 2:
Mailing Address - City:LAGUNA
Mailing Address - State:NM
Mailing Address - Zip Code:87026-0798
Mailing Address - Country:US
Mailing Address - Phone:505-552-6467
Mailing Address - Fax:505-552-0701
Practice Address - Street 1:I-40 WEST EXIT 114 BLDG 1125
Practice Address - Street 2:
Practice Address - City:LAGUNA
Practice Address - State:NM
Practice Address - Zip Code:87026-0798
Practice Address - Country:US
Practice Address - Phone:505-552-6467
Practice Address - Fax:505-552-0701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02204985001251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME7009Medicaid