Healthcare Provider Details

I. General information

NPI: 1477683316
Provider Name (Legal Business Name): COBRE CONSOLIDATED SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CENTRAL
BAYARD NM
88023
US

IV. Provider business mailing address

900 CENTRAL
BAYARD NM
88023
US

V. Phone/Fax

Practice location:
  • Phone: 505-537-4000
  • Fax: 505-537-3921
Mailing address:
  • Phone: 505-537-4000
  • Fax: 505-537-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAVIER SALAS
Title or Position: SPECIAL ED. DIRECTOR
Credential:
Phone: 505-537-4000