Provider Demographics
NPI:1013063411
Name:COUNTY OF PARK PLATTE CANYON SCHOOL DIST 1
Entity Type:Organization
Organization Name:COUNTY OF PARK PLATTE CANYON SCHOOL DIST 1
Other - Org Name:PLATTE CANYON SCHOOL DISTRICT 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS PAYABLE
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:KORTHUIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-679-7401
Mailing Address - Street 1:P.O. BOX 1069
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:CO
Mailing Address - Zip Code:80421
Mailing Address - Country:US
Mailing Address - Phone:303-679-7401
Mailing Address - Fax:303-679-7579
Practice Address - Street 1:57393 US HIGHWAY 285
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421
Practice Address - Country:US
Practice Address - Phone:303-679-7401
Practice Address - Fax:303-679-7579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04444154Medicaid