Provider Demographics
NPI:1891915963
Name:TOWN OF SHIRLEY
Entity Type:Organization
Organization Name:TOWN OF SHIRLEY
Other - Org Name:SHIRLEY SCHOOL DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:207-695-3708
Mailing Address - Street 1:89 WEST ROAD
Mailing Address - Street 2:PO BOX 148
Mailing Address - City:SHIRLEY
Mailing Address - State:ME
Mailing Address - Zip Code:04485
Mailing Address - Country:US
Mailing Address - Phone:207-695-3708
Mailing Address - Fax:
Practice Address - Street 1:89 WEST RD.
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:ME
Practice Address - Zip Code:04485
Practice Address - Country:US
Practice Address - Phone:207-695-3708
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME113210000Medicaid