Provider Demographics
NPI:1164720827
Name:RSU/SAD#60
Entity Type:Organization
Organization Name:RSU/SAD#60
Other - Org Name:NOBLE HEALTH CENTER AT NOBLE HIGH SCHOOL
Other - Org Type:Other Name
Authorized Official - Title/Position:ASSISTANT SUPERINTENDANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-676-2234
Mailing Address - Street 1:388 SOMERSWORTH RD
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-6559
Mailing Address - Country:US
Mailing Address - Phone:207-676-2175
Mailing Address - Fax:207-676-2204
Practice Address - Street 1:388 SOMERSWORTH RD
Practice Address - Street 2:
Practice Address - City:NORTH BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03906-6559
Practice Address - Country:US
Practice Address - Phone:207-676-2175
Practice Address - Fax:207-676-2204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECNP81654261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME321280099Medicaid