Provider Demographics
NPI:1679792022
Name:TOWN OF GREENVILLE
Entity Type:Organization
Organization Name:TOWN OF GREENVILLE
Other - Org Name:GREENVILLE SCHOOL DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-695-3708
Mailing Address - Street 1:100 PRITHAM AVE.
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04441-0100
Mailing Address - Country:US
Mailing Address - Phone:207-695-3708
Mailing Address - Fax:
Practice Address - Street 1:100 PRITHAM AVE.
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:ME
Practice Address - Zip Code:04441
Practice Address - Country:US
Practice Address - Phone:207-695-3708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X251300000X
ME251C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136630000Medicaid