Provider Demographics
NPI:1861529307
Name:ALBUQUERQUE CHARTER SCHOOL ALLIANCE
Entity type:Organization
Organization Name:ALBUQUERQUE CHARTER SCHOOL ALLIANCE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-344-5470
Mailing Address - Street 1:610 GOLD AVE SW
Mailing Address - Street 2:SUITE 224
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3146
Mailing Address - Country:US
Mailing Address - Phone:505-842-8203
Mailing Address - Fax:505-842-8074
Practice Address - Street 1:610 GOLD AVE SW
Practice Address - Street 2:SUITE 224
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3146
Practice Address - Country:US
Practice Address - Phone:505-842-8203
Practice Address - Fax:505-842-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
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
NM44676379Medicaid