Healthcare Provider Details

I. General information

NPI: 1669516654
Provider Name (Legal Business Name): COUNTY OF EL PASO SCHOOL DISTRICT 14
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 EL MONTE PL
MANITOU SPRINGS CO
80829-2502
US

IV. Provider business mailing address

405 EL MONTE PL
MANITOU SPRINGS CO
80829-2502
US

V. Phone/Fax

Practice location:
  • Phone: 719-685-2013
  • Fax: 719-685-4536
Mailing address:
  • Phone: 719-685-2013
  • Fax: 719-685-4536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: TRACI WOOFTER
Title or Position: MEDICAID COORDINATOR
Credential:
Phone: 719-290-6820