Provider Demographics
NPI:1700050390
Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT #75
Entity Type:Organization
Organization Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT #75
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRODSKY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:207-729-2951
Mailing Address - Street 1:73 EAGLES WAY
Mailing Address - Street 2:EAGLES NEST, MT. ARARAT HIGH SCHOOL
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1239
Mailing Address - Country:US
Mailing Address - Phone:207-729-2951
Mailing Address - Fax:207-725-0143
Practice Address - Street 1:73 EAGLES WAY
Practice Address - Street 2:MT. ARARAT HIGH SCHOOL
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-1239
Practice Address - Country:US
Practice Address - Phone:207-729-2951
Practice Address - Fax:207-725-0143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER047235261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME328370099Medicaid