Provider Demographics
NPI:1225153216
Name:TOWN OF EAST LONGMEADOW
Entity Type:Organization
Organization Name:TOWN OF EAST LONGMEADOW
Other - Org Name:EAST LONGMEADOW PUBLIC SCHOOLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:D
Authorized Official - Phone:413-525-5450
Mailing Address - Street 1:174 BRUSH HILL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1204
Mailing Address - Country:US
Mailing Address - Phone:413-735-2237
Mailing Address - Fax:413-735-2270
Practice Address - Street 1:180 MAPLE ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2721
Practice Address - Country:US
Practice Address - Phone:413-525-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1951378Medicaid