Healthcare Provider Details

I. General information

NPI: 1942413539
Provider Name (Legal Business Name): MAINE SCHOOL ADMINISTRATIVE DISTRICT NO. 46
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 MAIN STREET
DEXTER ME
04930
US

IV. Provider business mailing address

10 SPRING STREET
DEXTER ME
04930
US

V. Phone/Fax

Practice location:
  • Phone: 207-924-7669
  • Fax: 207-924-7676
Mailing address:
  • Phone: 207-924-5262
  • Fax: 207-924-7660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateME

VIII. Authorized Official

Name: MR. KEVIN JORDAN
Title or Position: SUPERINTENDENT
Credential:
Phone: 207-924-5262