Provider Demographics
NPI:1548383458
Name:MILLVILLE BOARD OF EDUCATION
Entity Type:Organization
Organization Name:MILLVILLE BOARD OF EDUCATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:SHAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:856-327-6035
Mailing Address - Street 1:110 N 3RD ST
Mailing Address - Street 2:PO BOX 5010
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-3302
Mailing Address - Country:US
Mailing Address - Phone:856-327-6035
Mailing Address - Fax:856-327-0891
Practice Address - Street 1:110 N 3RD ST
Practice Address - Street 2:CULVER CENTER - MILLVILLE BOARD OF ED
Practice Address - City:MILLVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08332-3302
Practice Address - Country:US
Practice Address - Phone:856-327-6035
Practice Address - Fax:856-327-0891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
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
NJ6494803Medicaid