Provider Demographics
NPI:1437379674
Name:SAU 41, BROOKLINE SCHOOL DISTRICT
Entity Type:Organization
Organization Name:SAU 41, BROOKLINE SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-465-7118
Mailing Address - Street 1:PO BOX 1588
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:03049-1588
Mailing Address - Country:US
Mailing Address - Phone:603-465-7118
Mailing Address - Fax:603-465-3933
Practice Address - Street 1:4 LUND LANE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NH
Practice Address - Zip Code:03049-1588
Practice Address - Country:US
Practice Address - Phone:603-465-7118
Practice Address - Fax:603-465-3933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
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
NH50008202Medicaid