Healthcare Provider Details

I. General information

NPI: 1881808913
Provider Name (Legal Business Name): MAINE SCHOOL ADMINISTRATIVE DISTRICT NO 72
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 PORTLAND STREET
FRYEBURG ME
04037
US

IV. Provider business mailing address

124 PORTLAND STREET
FRYEBURG ME
04037
US

V. Phone/Fax

Practice location:
  • Phone: 207-935-2600
  • Fax: 207-935-3787
Mailing address:
  • Phone: 207-935-2600
  • Fax: 207-935-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: NANCY HALL
Title or Position: DIRECTOR OF SPECIAL SERVICES
Credential:
Phone: 207-935-2600