1346455193 NPI number — SAD 29

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346455193 NPI number — SAD 29

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAD 29
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1346455193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
7 BIRD STREET
Provider Business Mailing Address City Name:
HOULTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04730-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-532-6555
Provider Business Mailing Address Fax Number:
207-532-6481

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 BIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOULTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04730-2402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-532-6555
Provider Business Practice Location Address Fax Number:
207-532-6481
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOREY
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
JERRY
Authorized Official Title or Position:
SPED ADMIN. ASSISTANT
Authorized Official Telephone Number:
207-538-3884

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 103250001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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