Provider Demographics
NPI:1083821144
Name:TOWN OF MOUNT DESERT
Entity Type:Organization
Organization Name:TOWN OF MOUNT DESERT
Other - Org Name:MT. DESERT SCHOOL DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIR. OF SPECIAL SVCS.
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSH SANBORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-288-5037
Mailing Address - Street 1:1081 EAGLE LAKE RD
Mailing Address - Street 2:
Mailing Address - City:MT. DESERT
Mailing Address - State:ME
Mailing Address - Zip Code:04660
Mailing Address - Country:US
Mailing Address - Phone:207-288-5037
Mailing Address - Fax:108-188-5058
Practice Address - Street 1:1081 EAGLE LAKE RD
Practice Address - Street 2:
Practice Address - City:MT. DESERT
Practice Address - State:ME
Practice Address - Zip Code:04660
Practice Address - Country:US
Practice Address - Phone:207-288-5037
Practice Address - Fax:108-188-5058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136900000Medicaid