Provider Demographics
NPI:1740493527
Name:MSAD #53
Entity type:Organization
Organization Name:MSAD #53
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:TARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-487-5107
Mailing Address - Street 1:167 SCHOOL STREET, SUITE A
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04967
Mailing Address - Country:US
Mailing Address - Phone:207-487-5711
Mailing Address - Fax:207-487-6310
Practice Address - Street 1:167 SCHOOL STREET, SUITE A
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:ME
Practice Address - Zip Code:04967
Practice Address - Country:US
Practice Address - Phone:207-487-5711
Practice Address - Fax:207-487-6310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103750000Medicaid