Provider Demographics
NPI:1376870295
Name:MSAD #63
Entity Type:Organization
Organization Name:MSAD #63
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-843-0702
Mailing Address - Street 1:202 KIDDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HOLDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04429-6222
Mailing Address - Country:US
Mailing Address - Phone:207-843-0702
Mailing Address - Fax:207-843-6403
Practice Address - Street 1:202 KIDDER HILL RD
Practice Address - Street 2:
Practice Address - City:HOLDEN
Practice Address - State:ME
Practice Address - Zip Code:04429-6222
Practice Address - Country:US
Practice Address - Phone:207-843-0702
Practice Address - Fax:207-843-6403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-13
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME253100000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104080000Medicaid