Provider Demographics
NPI:1841412434
Name:MSAD 25
Entity Type:Organization
Organization Name:MSAD 25
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DOE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-365-4272
Mailing Address - Street 1:805 STATION ROAD
Mailing Address - Street 2:
Mailing Address - City:STACYVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04777
Mailing Address - Country:US
Mailing Address - Phone:207-365-4272
Mailing Address - Fax:
Practice Address - Street 1:805 STATION ROAD
Practice Address - Street 2:
Practice Address - City:STACYVILLE
Practice Address - State:ME
Practice Address - Zip Code:04777
Practice Address - Country:US
Practice Address - Phone:207-365-4272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1031900001Medicaid