Provider Demographics
NPI:1588785703
Name:TOWN OF TEWKSBURY
Entity type:Organization
Organization Name:TOWN OF TEWKSBURY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-640-7800
Mailing Address - Street 1:139 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:TEWKSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01876-2725
Mailing Address - Country:US
Mailing Address - Phone:978-940-7805
Mailing Address - Fax:978-640-7808
Practice Address - Street 1:139 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:TEWKSBURY
Practice Address - State:MA
Practice Address - Zip Code:01876-2725
Practice Address - Country:US
Practice Address - Phone:978-640-7800
Practice Address - Fax:978-640-7808
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF TEWKSBURY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-03
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110030938BMedicaid