Provider Demographics
NPI:1942321922
Name:MARTHA'S VINEYARD SCHOOL DISTRICT
Entity Type:Organization
Organization Name:MARTHA'S VINEYARD SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF STUDENT SUPPORT SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:SEKLECKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-696-0156
Mailing Address - Street 1:4 PINE ST
Mailing Address - Street 2:
Mailing Address - City:VINEYARD HAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02568-6337
Mailing Address - Country:US
Mailing Address - Phone:508-696-0156
Mailing Address - Fax:508-693-3190
Practice Address - Street 1:4 PINE ST
Practice Address - Street 2:
Practice Address - City:VINEYARD HAVEN
Practice Address - State:MA
Practice Address - Zip Code:02568-6337
Practice Address - Country:US
Practice Address - Phone:508-696-0156
Practice Address - Fax:508-693-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1953702Medicaid