Healthcare Provider Details

I. General information

NPI: 1659713931
Provider Name (Legal Business Name): ALDO LEOPOLD CHARTER SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 07/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 HIGHWAY 180 E
SILVER CITY NM
88061-7837
US

IV. Provider business mailing address

1422 HIGHWAY 180 E
SILVER CITY NM
88061-7837
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-2547
  • Fax: 575-388-4970
Mailing address:
  • Phone: 575-538-2547
  • Fax: 575-388-4970

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: MADDY F LA ROSA-CORLISS
Title or Position: DEAN OF STUDENTS
Credential:
Phone: 575-538-2547