Provider Demographics
NPI:1669500344
Name:MCCLAVE SCHOOL DISTRICT RE2
Entity Type:Organization
Organization Name:MCCLAVE SCHOOL DISTRICT RE2
Other - Org Name:MCCLAVE SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-829-4517
Mailing Address - Street 1:PO BOX 1
Mailing Address - Street 2:
Mailing Address - City:MC CLAVE
Mailing Address - State:CO
Mailing Address - Zip Code:81057-0001
Mailing Address - Country:US
Mailing Address - Phone:719-829-4517
Mailing Address - Fax:
Practice Address - Street 1:308 LINCOLN STREET
Practice Address - Street 2:
Practice Address - City:MC CLAVE
Practice Address - State:CO
Practice Address - Zip Code:81057
Practice Address - Country:US
Practice Address - Phone:719-828-4517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84371561Medicaid