Provider Demographics
NPI:1801003207
Name:TOWN OF VASSALBORO
Entity Type:Organization
Organization Name:TOWN OF VASSALBORO
Other - Org Name:VASSALBORO PUBLIC SCHOOLS
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-923-3100
Mailing Address - Street 1:1116 WEBBER POND ROAD
Mailing Address - Street 2:
Mailing Address - City:VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04989
Mailing Address - Country:US
Mailing Address - Phone:207-923-3100
Mailing Address - Fax:207-923-3104
Practice Address - Street 1:1116 WEBBER POND ROAD
Practice Address - Street 2:
Practice Address - City:VASSALBORO
Practice Address - State:ME
Practice Address - Zip Code:04989
Practice Address - Country:US
Practice Address - Phone:207-923-3100
Practice Address - Fax:207-923-3104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME432345500251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432345500Medicaid