Provider Demographics
NPI:1124233960
Name:CITY OF SANFORD
Entity type:Organization
Organization Name:CITY OF SANFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:HANSON-DUGAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-608-8710
Mailing Address - Street 1:917 MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-3568
Mailing Address - Country:US
Mailing Address - Phone:207-324-7940
Mailing Address - Fax:
Practice Address - Street 1:917 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-3568
Practice Address - Country:US
Practice Address - Phone:207-324-7940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431500500Medicare ID - Type Unspecified