Provider Demographics
NPI:1669510434
Name:EAST OTERO SCHOOL DISTRICT R1
Entity Type:Organization
Organization Name:EAST OTERO SCHOOL DISTRICT R1
Other - Org Name:LA JUNTA
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MERINDA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:REISCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-384-6903
Mailing Address - Street 1:301 RATON AVE
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-1637
Mailing Address - Country:US
Mailing Address - Phone:719-384-6903
Mailing Address - Fax:
Practice Address - Street 1:301 RATON AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-1637
Practice Address - Country:US
Practice Address - Phone:719-384-6903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53559894Medicaid