Provider Demographics
NPI:1629298732
Name:ALAMOSA SCHOOL DISTRICT RE- 11J
Entity Type:Organization
Organization Name:ALAMOSA SCHOOL DISTRICT RE- 11J
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-587-6008
Mailing Address - Street 1:209 VICTORIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-4204
Mailing Address - Country:US
Mailing Address - Phone:719-587-1600
Mailing Address - Fax:719-587-1712
Practice Address - Street 1:401 VICTORIA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2230
Practice Address - Country:US
Practice Address - Phone:719-587-1650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO71681876Medicaid
CO=========OtherEIN