1730452202 NPI number — MARLBOROUGH PUBLIC SCHOOLS

Table of content: (NPI 1730452202)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730452202 NPI number — MARLBOROUGH PUBLIC SCHOOLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARLBOROUGH PUBLIC SCHOOLS
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:
RICHER ELEMENTARY SCHOOL
Provider Other Organization Name Type Code:
5
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:
1730452202
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29 AVALON DR
Provider Second Line Business Mailing Address:
PO BOX 194
Provider Business Mailing Address City Name:
WEST BROOKFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01585-2741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
617-939-6681
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 FOLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752-1922
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-624-6934
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/14/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
STOLGITIS
Authorized Official First Name:
KRISTIE
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
SCHOOL NURSE
Authorized Official Telephone Number:
508-624-6934

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  217062 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 281PC2000X , with the licence number: 217062 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282NC2000X , with the licence number: 217062 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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