Healthcare Provider Details

I. General information

NPI: 1033322920
Provider Name (Legal Business Name): MSAD #54
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 WEST FRONT STREET
SKOWHEGAN ME
04976
US

IV. Provider business mailing address

196 W FRONT ST
SKOWHEGAN ME
04976-5108
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-7424
  • Fax: 207-474-0001
Mailing address:
  • Phone: 207-474-7424
  • Fax: 207-474-0001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number251C00000X
License Number StateME

VIII. Authorized Official

Name: MRS. ANN BELANGER
Title or Position: SPECIAL SERVICES DIRECTOR
Credential:
Phone: 207-474-7424