Healthcare Provider Details

I. General information

NPI: 1992838056
Provider Name (Legal Business Name): REGIONAL SCHOOL DISTRICT 17
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 LITTLE CITY RD
HIGGANUM CT
06441-4323
US

IV. Provider business mailing address

57 LITTLE CITY RD
HIGGANUM CT
06441-4323
US

V. Phone/Fax

Practice location:
  • Phone: 860-345-4244
  • Fax: 860-345-3051
Mailing address:
  • Phone: 860-345-4244
  • Fax: 860-345-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY MALA
Title or Position: SUPERINTENDENT
Credential:
Phone: 860-345-4534