Healthcare Provider Details

I. General information

NPI: 1497007132
Provider Name (Legal Business Name): MCCURDY CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2012
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 S. MCCURDY RD.
ESPANOLA NM
87532
US

IV. Provider business mailing address

PO BOX 2250
ESPANOLA NM
87532-2250
US

V. Phone/Fax

Practice location:
  • Phone: 505-753-7221
  • Fax: 505-753-0192
Mailing address:
  • Phone: 505-753-7221
  • Fax: 505-753-0192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number
License Number State

VIII. Authorized Official

Name: MS. JANETTE ARCHULETA
Title or Position: DIRECTOR
Credential:
Phone: 505-753-7221