Healthcare Provider Details

I. General information

NPI: 1396264347
Provider Name (Legal Business Name): MONTE DEL SOL CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4157 WALKING RAIN RD
SANTA FE NM
87507-0825
US

IV. Provider business mailing address

4157 WALKING RAIN RD
SANTA FE NM
87507-0825
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-5225
  • Fax: 505-982-5321
Mailing address:
  • Phone: 505-982-5225
  • Fax: 505-982-5321

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: MARY ELLEN MADIGAN
Title or Position: SPECIAL SERVICES COORDINATOR
Credential:
Phone: 505-982-5225