1336377290 NPI number — CARE DEVELOPMENT OF MAINE

Table of content: (NPI 1336377290)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336377290 NPI number — CARE DEVELOPMENT OF MAINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE DEVELOPMENT OF MAINE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336377290
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 936
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANGOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04402-0936
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-945-4240
Provider Business Mailing Address Fax Number:
207-299-1102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 SUMMER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANGOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04401-6446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-945-4240
Provider Business Practice Location Address Fax Number:
207-299-1102
Provider Enumeration Date:
06/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
NELLIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
207-945-4240

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , with the licence number:  220602 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 133900000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com