Healthcare Provider Details

I. General information

NPI: 1669533972
Provider Name (Legal Business Name): TURQUOISE TRAIL ELEMENTARY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13A SAN MARCOS LOOP
SANTA FE NM
87508-8627
US

IV. Provider business mailing address

13A SAN MARCOS LOOP
SANTA FE NM
87508-8627
US

V. Phone/Fax

Practice location:
  • Phone: 505-467-1700
  • Fax: 505-474-7862
Mailing address:
  • Phone: 505-467-1700
  • Fax: 505-474-7862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License NumberM-04897
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2380
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3343
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number071155
License Number StateNM
# 5
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1975
License Number StateNM

VIII. Authorized Official

Name: RANDY FREEMAN
Title or Position: BUSINESS MANAGER
Credential:
Phone: 505-467-1770