Provider Demographics
NPI:1538364062
Name:MESA VISTA CONSOLIDATED SCHOOLS
Entity type:Organization
Organization Name:MESA VISTA CONSOLIDATED SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ARCHULETA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-581-4504
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:EL RITO
Mailing Address - State:NM
Mailing Address - Zip Code:87530-0006
Mailing Address - Country:US
Mailing Address - Phone:505-581-4504
Mailing Address - Fax:
Practice Address - Street 1:1253 A HWY 554
Practice Address - Street 2:
Practice Address - City:EL RITO
Practice Address - State:NM
Practice Address - Zip Code:87530-0006
Practice Address - Country:US
Practice Address - Phone:505-581-4504
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ8507Medicaid