Provider Demographics
NPI:1689758930
Name:JEFFERSON COUNTY SCHOOL DISTRICT R-1
Entity Type:Organization
Organization Name:JEFFERSON COUNTY SCHOOL DISTRICT R-1
Other - Org Name:JEFFCO PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:COORDINATOR, SCHOOL MEDICAID PROGRA
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-982-4502
Mailing Address - Street 1:1829 DENVER WEST DR BLDG 27
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3120
Mailing Address - Country:US
Mailing Address - Phone:303-982-6500
Mailing Address - Fax:
Practice Address - Street 1:1829 DENVER WEST DR BLDG 27
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3120
Practice Address - Country:US
Practice Address - Phone:303-982-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04444014Medicaid