Healthcare Provider Details

I. General information

NPI: 1164720827
Provider Name (Legal Business Name): RSU/SAD#60
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 SOMERSWORTH RD
NORTH BERWICK ME
03906-6559
US

IV. Provider business mailing address

388 SOMERSWORTH RD
NORTH BERWICK ME
03906-6559
US

V. Phone/Fax

Practice location:
  • Phone: 207-676-2175
  • Fax: 207-676-2204
Mailing address:
  • Phone: 207-676-2175
  • Fax: 207-676-2204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License NumberCNP81654
License Number StateME

VIII. Authorized Official

Name: MRS. SUSAN AUSTIN
Title or Position: ASSISTANT SUPERINTENDANT
Credential:
Phone: 207-676-2234