Healthcare Provider Details

I. General information

NPI: 1912110792
Provider Name (Legal Business Name): MAINE SCHOOL ADMINISTRATIVE DISTRICT NO 55
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 SO. HIRAM RD.
HIRAM ME
04041
US

IV. Provider business mailing address

137 SOUTH HIRAM ROAD
HIRAM ME
04041
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-3285
  • Fax:
Mailing address:
  • Phone: 207-625-2490
  • Fax: 207-625-7065

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: MS. JILL DEHMER
Title or Position: BUSINESS MANAGER
Credential:
Phone: 207-625-2490