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Organization
CENTRAL CONSOLIDATED SCHOOL DISTRICT #22
Active
Organization
CENTRAL CONSOLIDATED SCHOOL DISTRICT #22
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERICA HARVEY (MEDICAID SECRETARY)
(505) 368-5163
Entity
Organization
Contact information
Practice address
US HWY 64 OLD HIGH SCHOOL RD, SHIPROCK, NM 87420
(505) 368-5163
(505) 368-5502
Mailing address
PO BOX 1319, SHIPROCK, NM 87420-1319
(505) 368-5163
(505) 368-5502
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
J7695
—
NM
Enumeration date
02/20/2007
Last updated
08/22/2020
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