Provider Demographics
NPI:1619184207
Name:MSAD 7
Entity Type:Organization
Organization Name:MSAD 7
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR OF SPECIAL SERVICES
Authorized Official - Prefix:MISS
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:207-867-4707
Mailing Address - Street 1:RR 1 BOX 699
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:ME
Mailing Address - Zip Code:04853-9707
Mailing Address - Country:US
Mailing Address - Phone:207-867-4707
Mailing Address - Fax:207-867-4438
Practice Address - Street 1:RR 1 BOX 699
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:ME
Practice Address - Zip Code:04853-9707
Practice Address - Country:US
Practice Address - Phone:207-867-4707
Practice Address - Fax:207-867-4438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME137730000Medicaid