Provider Demographics
NPI:1063540185
Name:CHAMA VALLEY INDEPENDENT SCHOOLS
Entity type:Organization
Organization Name:CHAMA VALLEY INDEPENDENT SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. SUPERINTENDANT SPED DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:CASADOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-588-7660
Mailing Address - Street 1:P.O. DRAWER 10
Mailing Address - Street 2:
Mailing Address - City:TIERRA AMARILLA
Mailing Address - State:NM
Mailing Address - Zip Code:87575-9701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:STATE ROAD 531
Practice Address - Street 2:BUILDING 032
Practice Address - City:GIERRA AMARILLA
Practice Address - State:NM
Practice Address - Zip Code:87575
Practice Address - Country:US
Practice Address - Phone:505-588-7660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
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
NML9498Medicaid