Provider Demographics
NPI:1811227101
Name:GREENBUSH SCHOOL DEPARTMENT
Entity type:Organization
Organization Name:GREENBUSH SCHOOL DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-732-3112
Mailing Address - Street 1:129 MILITARY RD
Mailing Address - Street 2:
Mailing Address - City:GREENBUSH
Mailing Address - State:ME
Mailing Address - Zip Code:04418-3137
Mailing Address - Country:US
Mailing Address - Phone:207-826-2000
Mailing Address - Fax:207-826-2001
Practice Address - Street 1:129 MILITARY RD
Practice Address - Street 2:
Practice Address - City:GREENBUSH
Practice Address - State:ME
Practice Address - Zip Code:04418-3137
Practice Address - Country:US
Practice Address - Phone:207-826-2000
Practice Address - Fax:207-826-2001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF GREENBUSH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QH0100X, 261QM0801X, 261QR0400X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136620000Medicaid