Provider Demographics
NPI:1912073909
Name:PORTALES MUNICIPAL SCHOOLS
Entity Type:Organization
Organization Name:PORTALES MUNICIPAL SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SSS
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNICA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-359-3707
Mailing Address - Street 1:501 S ABILENE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6380
Mailing Address - Country:US
Mailing Address - Phone:505-359-3707
Mailing Address - Fax:505-356-6682
Practice Address - Street 1:501 S ABILENE AVE
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6380
Practice Address - Country:US
Practice Address - Phone:505-359-3707
Practice Address - Fax:505-356-6682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM39008371251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39008371Medicaid