Healthcare Provider Details

I. General information

NPI: 1811227101
Provider Name (Legal Business Name): GREENBUSH SCHOOL DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

129 MILITARY RD
GREENBUSH ME
04418-3137
US

IV. Provider business mailing address

129 MILITARY RD
GREENBUSH ME
04418-3137
US

V. Phone/Fax

Practice location:
  • Phone: 207-826-2000
  • Fax: 207-826-2001
Mailing address:
  • Phone: 207-826-2000
  • Fax: 207-826-2001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateME

VIII. Authorized Official

Name: JERRY WHITE
Title or Position: SUPERINTENDENT
Credential:
Phone: 207-732-3112