Healthcare Provider Details

I. General information

NPI: 1831426006
Provider Name (Legal Business Name): TOWN OF WILLIMANTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 PRITHAM AVENUE
GREENVILLE ME
04441-0000
US

IV. Provider business mailing address

144 PRITHAM AVENUE
GREENVILLE ME
04441-0000
US

V. Phone/Fax

Practice location:
  • Phone: 207-695-3708
  • Fax: 207-695-3709
Mailing address:
  • Phone: 207-695-3708
  • Fax: 207-695-3709

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: MRS. HEATHER JANE PERRY
Title or Position: SUPERINTENDENT
Credential: ME.D
Phone: 207-695-3708