Provider Demographics
NPI:1710016977
Name:MONTEZUMA COUNTY SCHOOL DISTRICT RE-6
Entity Type:Organization
Organization Name:MONTEZUMA COUNTY SCHOOL DISTRICT RE-6
Other - Org Name:MANCOS SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-533-7748
Mailing Address - Street 1:395 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANCOS
Mailing Address - State:CO
Mailing Address - Zip Code:81328-9071
Mailing Address - Country:US
Mailing Address - Phone:970-533-7748
Mailing Address - Fax:
Practice Address - Street 1:395 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MANCOS
Practice Address - State:CO
Practice Address - Zip Code:81328-9071
Practice Address - Country:US
Practice Address - Phone:970-533-7748
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
CO45571074Medicaid