Provider Demographics
NPI:1871708230
Name:STATE OF MAINE
Entity type:Organization
Organization Name:STATE OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR STATE SCHOOLS DEPT OF EDUCATION
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:F
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:EUT
Authorized Official - Phone:207-624-6892
Mailing Address - Street 1:23 STATE HOUSE STA
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04333-0023
Mailing Address - Country:US
Mailing Address - Phone:207-624-6893
Mailing Address - Fax:207-624-6891
Practice Address - Street 1:23 STATE HOUSE STA
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0023
Practice Address - Country:US
Practice Address - Phone:207-624-6893
Practice Address - Fax:207-624-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132170000Medicaid