Provider Demographics
NPI:1336360551
Name:DEER ISLE STONINGTON CSD 13
Entity Type:Organization
Organization Name:DEER ISLE STONINGTON CSD 13
Other - Org Name:SCHOOL UNION 76
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:DSS
Authorized Official - Phone:207-359-8400
Mailing Address - Street 1:9 CATERPILLAR HILL RD
Mailing Address - Street 2:
Mailing Address - City:SARGENTVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04673-2463
Mailing Address - Country:US
Mailing Address - Phone:207-359-8400
Mailing Address - Fax:207-359-8451
Practice Address - Street 1:9 CATERPILLAR HILL RD
Practice Address - Street 2:
Practice Address - City:SARGENTVILLE
Practice Address - State:ME
Practice Address - Zip Code:04673-2463
Practice Address - Country:US
Practice Address - Phone:207-359-8400
Practice Address - Fax:207-359-8451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME106310000Medicaid