Provider Demographics
NPI:1295946622
Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT NO. 42
Entity type:Organization
Organization Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT NO. 42
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-425-3771
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04758-1006
Mailing Address - Country:US
Mailing Address - Phone:207-425-3771
Mailing Address - Fax:
Practice Address - Street 1:35 PLEASANT STREET
Practice Address - Street 2:
Practice Address - City:MARS HILL
Practice Address - State:ME
Practice Address - Zip Code:04758
Practice Address - Country:US
Practice Address - Phone:207-429-8514
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103570100Medicaid