Provider Demographics
NPI:1194861989
Name:TOWN OF GLOCESTER
Entity Type:Organization
Organization Name:TOWN OF GLOCESTER
Other - Org Name:NORTHWEST SPECIAL EDUCATION REGION
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION REGIO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-647-4106
Mailing Address - Street 1:23A THEODORE FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:NORTH SCITUATE
Mailing Address - State:RI
Mailing Address - Zip Code:02857-1066
Mailing Address - Country:US
Mailing Address - Phone:401-647-4106
Mailing Address - Fax:401-647-4107
Practice Address - Street 1:23A THEODORE FOSTER DR
Practice Address - Street 2:
Practice Address - City:NORTH SCITUATE
Practice Address - State:RI
Practice Address - Zip Code:02857-1066
Practice Address - Country:US
Practice Address - Phone:401-647-4106
Practice Address - Fax:401-647-4107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
RITG 17174Medicaid