Healthcare Provider Details

I. General information

NPI: 1336269588
Provider Name (Legal Business Name): OLD COLONY REGIONAL VOCATIONAL TECHNICAL HIGH SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

476 NORTH AVE
ROCHESTER MA
02770-1811
US

IV. Provider business mailing address

476 NORTH AVE
ROCHESTER MA
02770-1811
US

V. Phone/Fax

Practice location:
  • Phone: 508-763-8011
  • Fax: 508-763-9821
Mailing address:
  • Phone: 508-763-8011
  • Fax: 508-763-9821

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: BRUCE KAISER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 508-763-8011