Provider Demographics
NPI:1730307505
Name:SHORE EDUCATIONAL COLLABORATIVE
Entity Type:Organization
Organization Name:SHORE EDUCATIONAL COLLABORATIVE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MS
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-887-2930
Mailing Address - Street 1:4 AUDUBON RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-1203
Mailing Address - Country:US
Mailing Address - Phone:781-224-3466
Mailing Address - Fax:
Practice Address - Street 1:4 AUDUBON RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-1203
Practice Address - Country:US
Practice Address - Phone:781-224-3466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1308947Medicaid