Provider Demographics
NPI:1720105406
Name:MONTACHUSETT REGIONAL VOCATIONAL TECHNICAL SCHOOL DISTRICT
Entity type:Organization
Organization Name:MONTACHUSETT REGIONAL VOCATIONAL TECHNICAL SCHOOL DISTRICT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENDENT-DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:CULKEEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-345-9200
Mailing Address - Street 1:1050 WESTMINSTER ST
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:MA
Mailing Address - Zip Code:01420-4649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:978-345-9165
Practice Address - Street 1:1050 WESTMINSTER ST
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-4649
Practice Address - Country:US
Practice Address - Phone:978-345-9200
Practice Address - Fax:978-345-9165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1952919Medicaid