MEDICARE: RIO GALLINAS SCHOOL FOR ECOLOGY AND THE ARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251300000X	Local Education Agency (LEA)		NM

General Provider Information

NPI Number	:	1104218072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIO GALLINAS SCHOOL FOR ECOLOGY AND THE ARTS

Provider Business Mailing Address
First Line	:	1107 MONTEZUMA ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3519
Country	:	US
Telephone Number	:	505-454-8687
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 MONTEZUMA ST
Second Line	:
City	:	LAS VEGAS
State	:	NM
Zip	:	87701-3519
Country	:	US
Telephone Number	:	505-454-8687
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. GERALD GARCIA
Credential	:
Telephone Number	:	505-454-8687

Provider Enumeration Date	:	03/02/2015
Last Update Date	:	03/02/2015

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