Healthcare Provider Details

I. General information

NPI: 1902019706
Provider Name (Legal Business Name): MSAD45
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

33 SCHOOL ST
WASHBURN ME
04786-3233
US

IV. Provider business mailing address

33 SCHOOL ST
WASHBURN ME
04786-3233
US

V. Phone/Fax

Practice location:
  • Phone: 207-455-8301
  • Fax: 207-455-8217
Mailing address:
  • Phone: 207-455-8301
  • Fax: 207-455-8217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. BROOKE CLENCHY
Title or Position: SUPERINTENDENT OF SCHOOLS
Credential:
Phone: 207-455-8301