Healthcare Provider Details

I. General information

NPI: 1134347156
Provider Name (Legal Business Name): SPENCER-EAST BROOKFIELD REG. SCHOOL DIST.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 MAIN STREET
SPENCER MA
01562
US

IV. Provider business mailing address

306 MAIN STREET
SPENCER MA
01562
US

V. Phone/Fax

Practice location:
  • Phone: 508-885-8500
  • Fax: 508-885-8504
Mailing address:
  • Phone: 508-885-8500
  • Fax: 508-885-8504

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: DR. RALPH HICKS
Title or Position: SUPERINTENDENT OF SCHOOLS
Credential:
Phone: 508-885-8500