Provider Demographics
NPI:1861515488
Name:THOMPSON PUBLIC SCHOOLS
Entity type:Organization
Organization Name:THOMPSON PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERINTENDENT OF SCHOOLS
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:860-923-9581
Mailing Address - Street 1:785 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH GROSVENORDALE
Mailing Address - State:CT
Mailing Address - Zip Code:06255-2126
Mailing Address - Country:US
Mailing Address - Phone:860-923-9581
Mailing Address - Fax:860-923-9638
Practice Address - Street 1:785 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH GROSVENORDALE
Practice Address - State:CT
Practice Address - Zip Code:06255-2126
Practice Address - Country:US
Practice Address - Phone:860-923-9581
Practice Address - Fax:860-923-9638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2014-12-31
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2014-12-31
Provider Licenses
StateLicense IDTaxonomies
CT004206571251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004206571Medicaid