Provider Demographics
NPI:1629107891
Name:GUNNISON COUNTY SCHOOL DISTRICT RE1J
Entity Type:Organization
Organization Name:GUNNISON COUNTY SCHOOL DISTRICT RE1J
Other - Org Name:GUNNISON SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:SPED DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'DEA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-641-7770
Mailing Address - Street 1:800 N BOULEVARD ST
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-2825
Mailing Address - Country:US
Mailing Address - Phone:970-641-7770
Mailing Address - Fax:
Practice Address - Street 1:800 N BOULEVARD ST
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2825
Practice Address - Country:US
Practice Address - Phone:970-641-7770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20177216Medicaid