Provider Demographics
NPI:1053524645
Name:MSAD #17
Entity type:Organization
Organization Name:MSAD #17
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-743-8972
Mailing Address - Street 1:1570 MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:OXFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04270-3390
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1570 MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3390
Practice Address - Country:US
Practice Address - Phone:207-743-8972
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251C00000X251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services