Healthcare Provider Details

I. General information

NPI: 1801003207
Provider Name (Legal Business Name): TOWN OF VASSALBORO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 WEBBER POND ROAD
VASSALBORO ME
04989
US

IV. Provider business mailing address

1116 WEBBER POND ROAD
VASSALBORO ME
04989
US

V. Phone/Fax

Practice location:
  • Phone: 207-923-3100
  • Fax: 207-923-3104
Mailing address:
  • Phone: 207-923-3100
  • Fax: 207-923-3104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number432345500
License Number StateME

VIII. Authorized Official

Name: MS. DIANNA L GRAM
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential:
Phone: 207-923-3100