Provider Demographics
NPI:1316166580
Name:OLD TOWN SCHOOL DEPT.
Entity type:Organization
Organization Name:OLD TOWN SCHOOL DEPT.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INTERIM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOUCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-827-4441
Mailing Address - Street 1:P.O. BOX 543
Mailing Address - Street 2:21 JEFFERSON STREET
Mailing Address - City:OLD TOWN
Mailing Address - State:ME
Mailing Address - Zip Code:04468-0543
Mailing Address - Country:US
Mailing Address - Phone:207-827-4441
Mailing Address - Fax:207-827-4449
Practice Address - Street 1:21 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:OLD TOWN
Practice Address - State:ME
Practice Address - Zip Code:04468-2106
Practice Address - Country:US
Practice Address - Phone:207-827-4441
Practice Address - Fax:207-827-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136030002Medicaid