Provider Demographics
NPI:1871670901
Name:MOUNTAIN VALLEY SCHOOL
Entity Type:Organization
Organization Name:MOUNTAIN VALLEY SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN SCHOOL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HAMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-655-2578
Mailing Address - Street 1:PO BOX 127
Mailing Address - Street 2:403 PITKIN AVE
Mailing Address - City:SAGUACHE
Mailing Address - State:CO
Mailing Address - Zip Code:81149
Mailing Address - Country:US
Mailing Address - Phone:719-655-0267
Mailing Address - Fax:719-655-0269
Practice Address - Street 1:403 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:SAGUACHE
Practice Address - State:CO
Practice Address - Zip Code:81149
Practice Address - Country:US
Practice Address - Phone:719-655-0267
Practice Address - Fax:719-655-0269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
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
CO00873233Medicaid