Healthcare Provider Details

I. General information

NPI: 1619184207
Provider Name (Legal Business Name): MSAD 7
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 12/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RR 1 BOX 699
NORTH HAVEN ME
04853-9707
US

IV. Provider business mailing address

RR 1 BOX 699
NORTH HAVEN ME
04853-9707
US

V. Phone/Fax

Practice location:
  • Phone: 207-867-4707
  • Fax: 207-867-4438
Mailing address:
  • Phone: 207-867-4707
  • Fax: 207-867-4438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number StateME

VIII. Authorized Official

Name: MISS HOLLY J BLAKE
Title or Position: COORDINATOR OF SPECIAL SERVICES
Credential: M.A.
Phone: 207-867-4707