Healthcare Provider Details

I. General information

NPI: 1760607188
Provider Name (Legal Business Name): MAINE SCHOOL ADMINISTRATIVE DISTRICT 34
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6A LIONS WAY
BELFAST ME
04915-0363
US

IV. Provider business mailing address

PO BOX 363
BELFAST ME
04915-0363
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-1960
  • Fax: 207-338-4597
Mailing address:
  • Phone: 207-338-1960
  • Fax: 207-338-4597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. BRUCE MAILLOUX
Title or Position: SUPERINTENDENT OF SCHOOLS
Credential:
Phone: 207-338-1960