Organization
JEFFERSON
Active
Other names
AOS 93
Organization subpart
No
Provider details
NPI number
Authorized official
DERYL C. HOLT (DIRECTOR OF SPECIAL SERVICES)
(207) 563-3044
Entity
Organization
Contact information
Practice address
767 MAIN ST # 1A, DAMARISCOTTA, ME 04543-4664
(207) 563-3044
(207) 563-8276
Mailing address
767 MAIN ST # 1A, DAMARISCOTTA, ME 04543-4664
(207) 563-3044
(207) 563-8276
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136720000
—
ME
Enumeration date
11/17/2009
Last updated
11/17/2009
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