Provider Demographics
NPI:1275744740
Name:MSAD1
Entity Type:Organization
Organization Name:MSAD1
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:WAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-3036
Mailing Address - Street 1:79 BLAKE ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2474
Mailing Address - Country:US
Mailing Address - Phone:207-764-3036
Mailing Address - Fax:207-768-3445
Practice Address - Street 1:79 BLAKE ST
Practice Address - Street 2:SUITE #1
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2474
Practice Address - Country:US
Practice Address - Phone:207-764-3036
Practice Address - Fax:207-768-3445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services