Provider Demographics
NPI:1881801777
Name:DEDHAM SCHOOL DEPT.
Entity type:Organization
Organization Name:DEDHAM SCHOOL DEPT.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIAL EDUCATION DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-989-8636
Mailing Address - Street 1:49 CAPRI ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1362
Mailing Address - Country:US
Mailing Address - Phone:207-989-3160
Mailing Address - Fax:207-989-8622
Practice Address - Street 1:2065 MAIN RD
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:ME
Practice Address - Zip Code:04429-4400
Practice Address - Country:US
Practice Address - Phone:207-843-6498
Practice Address - Fax:207-843-4330
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF DEDHAM, OFFICE OF TREASURER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136440000Medicaid