Healthcare Provider Details

I. General information

NPI: 1679663066
Provider Name (Legal Business Name): EAST HADDAM PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 PLAINS RD
MOODUS CT
06469
US

IV. Provider business mailing address

26 PLAINS RD P.O. BOX 401
MOODUS CT
06469
US

V. Phone/Fax

Practice location:
  • Phone: 860-873-5090
  • Fax: 860-873-5092
Mailing address:
  • Phone: 860-873-5090
  • Fax: 860-873-5092

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. ROBERT T CARROLL
Title or Position: BUSINESS MANAGER
Credential:
Phone: 860-873-5090