1669533972 NPI number — TURQUOISE TRAIL ELEMENTARY SCHOOL

Table of content: (NPI 1669533972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669533972 NPI number — TURQUOISE TRAIL ELEMENTARY SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TURQUOISE TRAIL ELEMENTARY SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669533972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13A SAN MARCOS LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA FE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87508-8627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-467-1700
Provider Business Mailing Address Fax Number:
505-474-7862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13A SAN MARCOS LOOP
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA FE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87508-8627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-467-1700
Provider Business Practice Location Address Fax Number:
505-474-7862
Provider Enumeration Date:
12/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
RANDY
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
505-467-1770

Provider Taxonomy Codes

  • Taxonomy code: 101YS0200X , with the licence number:  M-04897 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , with the licence number: 2380 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225X00000X , with the licence number: 1975 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 235Z00000X , with the licence number: 3343 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251300000X , with the licence number: 071155 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 85826855 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".