Healthcare Provider Details

I. General information

NPI: 1801093646
Provider Name (Legal Business Name): MSAD 5
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 LINCOLN ST
ROCKLAND ME
04841
US

IV. Provider business mailing address

28 LINCOLN ST
ROCKLAND ME
04841
US

V. Phone/Fax

Practice location:
  • Phone: 207-596-6620
  • Fax: 207-596-2004
Mailing address:
  • Phone: 207-596-6620
  • Fax: 207-596-2004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: TONI REED
Title or Position: BUSINESS MANGER
Credential:
Phone: 207-596-2001