Provider Demographics
NPI:1336233220
Name:LOS LUNAS SCHOOLS
Entity Type:Organization
Organization Name:LOS LUNAS SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WELLNESS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:
Authorized Official - Last Name:TILLOTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-866-8331
Mailing Address - Street 1:SPECIAL SERVICES
Mailing Address - Street 2:PO DRAWER 1300
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031
Mailing Address - Country:US
Mailing Address - Phone:505-866-8331
Mailing Address - Fax:505-866-2180
Practice Address - Street 1:SPECIAL SERVICES
Practice Address - Street 2:343 MAIN ST.
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031
Practice Address - Country:US
Practice Address - Phone:505-866-8331
Practice Address - Fax:505-866-2180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME7706Medicaid