Provider Demographics
NPI:1730306945
Name:TOWN OF LUNENBURG
Entity Type:Organization
Organization Name:TOWN OF LUNENBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STUDENT SERVICES COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BLAISDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-582-4114
Mailing Address - Street 1:1033 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:LUNENBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01462-1479
Mailing Address - Country:US
Mailing Address - Phone:978-582-4114
Mailing Address - Fax:978-582-9348
Practice Address - Street 1:1033 MASSACHUSETTS AVENUE
Practice Address - Street 2:
Practice Address - City:LUNENBURG
Practice Address - State:MA
Practice Address - Zip Code:01462-1479
Practice Address - Country:US
Practice Address - Phone:978-582-4114
Practice Address - Fax:978-582-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952617Medicaid