Healthcare Provider Details

I. General information

NPI: 1154831451
Provider Name (Legal Business Name): ANANSI CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2017
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 STATE HIGHWAY 230
EL PRADO NM
87529
US

IV. Provider business mailing address

57 STATE HIGHWAY 230
EL PRADO NM
87529
US

V. Phone/Fax

Practice location:
  • Phone: 575-776-2256
  • Fax: 575-776-5561
Mailing address:
  • Phone: 575-776-2256
  • Fax: 575-776-5561

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: RAYNE MEDINA
Title or Position: SECRETARY
Credential:
Phone: 575-776-2256