Provider Demographics
NPI:1689791261
Name:NORTH SHORE REGIONAL HIGH SCHOOL
Entity Type:Organization
Organization Name:NORTH SHORE REGIONAL HIGH SCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'MALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-762-0001
Mailing Address - Street 1:30 LOG BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01949-2252
Mailing Address - Country:US
Mailing Address - Phone:978-762-0001
Mailing Address - Fax:978-762-4589
Practice Address - Street 1:30 LOG BRIDGE RD
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:MA
Practice Address - Zip Code:01949-2252
Practice Address - Country:US
Practice Address - Phone:978-762-0001
Practice Address - Fax:978-762-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1953494251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1953494Medicaid