Provider Demographics
NPI:1033322920
Name:MSAD #54
Entity Type:Organization
Organization Name:MSAD #54
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL SERVICES DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:BELANGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-474-7424
Mailing Address - Street 1:196 W FRONT ST
Mailing Address - Street 2:
Mailing Address - City:SKOWHEGAN
Mailing Address - State:ME
Mailing Address - Zip Code:04976-5108
Mailing Address - Country:US
Mailing Address - Phone:207-474-7424
Mailing Address - Fax:207-474-0001
Practice Address - Street 1:199 WEST FRONT STREET
Practice Address - Street 2:
Practice Address - City:SKOWHEGAN
Practice Address - State:ME
Practice Address - Zip Code:04976
Practice Address - Country:US
Practice Address - Phone:207-474-7424
Practice Address - Fax:207-474-0001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251C00000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME251C00000XMedicaid