Provider Demographics
NPI:1972725372
Name:EAST MILLINOCKET SCHOOL DEPARTMENT
Entity Type:Organization
Organization Name:EAST MILLINOCKET SCHOOL DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DISSELKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:207-746-3514
Mailing Address - Street 1:45 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:EAST MILLINOCKET
Mailing Address - State:ME
Mailing Address - Zip Code:04462
Mailing Address - Country:US
Mailing Address - Phone:207-746-3514
Mailing Address - Fax:
Practice Address - Street 1:45 NORTH STREET
Practice Address - Street 2:
Practice Address - City:EAST MILLINOCKET
Practice Address - State:ME
Practice Address - Zip Code:04462
Practice Address - Country:US
Practice Address - Phone:207-746-3514
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
ME-16000149251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========Medicaid