Provider Demographics
NPI:1992833701
Name:LA PLATA COUNTY SCHOOL DISTRICT 11 JT
Entity Type:Organization
Organization Name:LA PLATA COUNTY SCHOOL DISTRICT 11 JT
Other - Org Name:IGNACIO SCHOOL DISTRICT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:PESKUSKI
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:970-563-0500
Mailing Address - Street 1:315 IGNACIO STREET
Mailing Address - Street 2:
Mailing Address - City:IGNACIO
Mailing Address - State:CO
Mailing Address - Zip Code:81137
Mailing Address - Country:US
Mailing Address - Phone:970-563-0500
Mailing Address - Fax:970-563-4524
Practice Address - Street 1:315 IGNACIO STREET
Practice Address - Street 2:
Practice Address - City:IGNACIO
Practice Address - State:CO
Practice Address - Zip Code:81137
Practice Address - Country:US
Practice Address - Phone:970-563-0500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57680345Medicaid