Provider Demographics
NPI:1770799066
Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT 59
Entity type:Organization
Organization Name:MAINE SCHOOL ADMINISTRATIVE DISTRICT 59
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHRISTOPHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-696-3900
Mailing Address - Street 1:55 WESTON AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:ME
Mailing Address - Zip Code:04950-1227
Mailing Address - Country:US
Mailing Address - Phone:207-696-3323
Mailing Address - Fax:207-696-5631
Practice Address - Street 1:55 WESTON AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:ME
Practice Address - Zip Code:04950-1227
Practice Address - Country:US
Practice Address - Phone:207-696-3323
Practice Address - Fax:207-696-5631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103950002Medicaid