Healthcare Provider Details

I. General information

NPI: 1952434540
Provider Name (Legal Business Name): MORA INDEPENDENT SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HIGHWAY 518 RANGER RD
MORA NM
87732
US

IV. Provider business mailing address

PO BOX 179
MORA NM
87732-0179
US

V. Phone/Fax

Practice location:
  • Phone: 505-387-3109
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number247324
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number122095
License Number StateNM

VIII. Authorized Official

Name: ANN GARCIA
Title or Position: MEDICAID COORDINATOR
Credential:
Phone: 505-387-3109