Provider Demographics
NPI:1760679773
Name:CONEJOS COUNTY SCHOOL DISTRICT #6J
Entity Type:Organization
Organization Name:CONEJOS COUNTY SCHOOL DISTRICT #6J
Other - Org Name:SANFORD SCHOOL DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:COORDINATOR
Authorized Official - Phone:719-587-5413
Mailing Address - Street 1:2261 ENTERPRISE ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-3603
Mailing Address - Country:US
Mailing Address - Phone:719-589-5851
Mailing Address - Fax:719-589-5007
Practice Address - Street 1:2261 ENTERPRISE ST
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-3603
Practice Address - Country:US
Practice Address - Phone:719-589-5851
Practice Address - Fax:719-589-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97438561OtherPROVIDER
CO=========OtherEIN