Provider Demographics
NPI:1629100581
Name:TOWN OF IPSWICH
Entity Type:Organization
Organization Name:TOWN OF IPSWICH
Other - Org Name:IPSWICH PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:ED D
Authorized Official - Phone:978-356-2935
Mailing Address - Street 1:1 LORD SQ
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LORD SQ
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1909
Practice Address - Country:US
Practice Address - Phone:978-356-2935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF IPSWICH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-09
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1953435Medicaid