Provider Demographics
NPI:1356464085
Name:OAK BLUFFS SCHOOL
Entity Type:Organization
Organization Name:OAK BLUFFS SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SUPPORT SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEKLECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-696-0156
Mailing Address - Street 1:P.O. BOX 1325
Mailing Address - Street 2:
Mailing Address - City:OAK BLUFFS
Mailing Address - State:MA
Mailing Address - Zip Code:02557
Mailing Address - Country:US
Mailing Address - Phone:508-693-0951
Mailing Address - Fax:508-693-5189
Practice Address - Street 1:4 PINE ST
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-6337
Practice Address - Country:US
Practice Address - Phone:508-696-0156
Practice Address - Fax:508-693-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1950991Medicaid