Provider Demographics
NPI:1962621144
Name:TOWN OF JAY, JAY SCHOOL DEPARTMENT
Entity type:Organization
Organization Name:TOWN OF JAY, JAY SCHOOL DEPARTMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-897-5271
Mailing Address - Street 1:12 TIGER DR
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239-1518
Mailing Address - Country:US
Mailing Address - Phone:207-897-5271
Mailing Address - Fax:207-897-4657
Practice Address - Street 1:12 TIGER DR
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-1518
Practice Address - Country:US
Practice Address - Phone:207-897-5271
Practice Address - Fax:207-897-4657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME136710000Medicaid