Provider Demographics
NPI:1215046842
Name:ADAMS 12 FIVE STAR SCHOOLS
Entity type:Organization
Organization Name:ADAMS 12 FIVE STAR SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BUNJES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-972-4790
Mailing Address - Street 1:1500 E 128TH AVE
Mailing Address - Street 2:ATTN: MEDICAID DEPARTMENT
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241
Mailing Address - Country:US
Mailing Address - Phone:720-972-4790
Mailing Address - Fax:
Practice Address - Street 1:1500 E 128TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2601
Practice Address - Country:US
Practice Address - Phone:720-972-4790
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04444089Medicaid