Provider Demographics
NPI:1821201609
Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT NO 55
Entity Type:Organization
Organization Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT NO 55
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-625-2490
Mailing Address - Street 1:137 SOUTH HIRAM ROAD
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:ME
Mailing Address - Zip Code:04041
Mailing Address - Country:US
Mailing Address - Phone:207-625-2490
Mailing Address - Fax:207-625-7065
Practice Address - Street 1:213 SO. HIRAM RD.
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:ME
Practice Address - Zip Code:04041
Practice Address - Country:US
Practice Address - Phone:207-625-3285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103830002Medicaid