Provider Demographics
NPI:1790994176
Name:CITY OF SOUTH PORTLAND
Entity Type:Organization
Organization Name:CITY OF SOUTH PORTLAND
Other - Org Name:SOUTH PORTLAND SCHOOL DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:H
Authorized Official - Last Name:HOULIHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-871-0555
Mailing Address - Street 1:130 WESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3420
Mailing Address - Country:US
Mailing Address - Phone:207-871-0555
Mailing Address - Fax:207-871-0559
Practice Address - Street 1:130 WESCOTT RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3420
Practice Address - Country:US
Practice Address - Phone:207-871-0555
Practice Address - Fax:207-871-0559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services