Provider Demographics
NPI:1700962933
Name:SAGUACHE COUNTY #2
Entity type:Organization
Organization Name:SAGUACHE COUNTY #2
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:R
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:719-256-4710
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:MOFFAT
Mailing Address - State:CO
Mailing Address - Zip Code:81143
Mailing Address - Country:US
Mailing Address - Phone:719-256-4710
Mailing Address - Fax:719-256-4730
Practice Address - Street 1:501 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOFFAT
Practice Address - State:CO
Practice Address - Zip Code:81143
Practice Address - Country:US
Practice Address - Phone:719-256-4710
Practice Address - Fax:719-256-4730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO20672233Medicaid