1598977282 NPI number — CALAIS DAY TREATMENT

Table of content: (NPI 1598977282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598977282 NPI number — CALAIS DAY TREATMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CALAIS DAY TREATMENT
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:
SCHOOL UNION 106
Provider Other Organization Name Type Code:
5
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:
1598977282
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 BLUE DEVIL HL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALAIS
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04619-4037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
120-745-4282
Provider Business Mailing Address Fax Number:
120-745-4251

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32 BLUE DEVIL HL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALAIS
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04619-4037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
120-745-4282
Provider Business Practice Location Address Fax Number:
120-745-4251
Provider Enumeration Date:
05/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
UNDERWOOD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
12074542821

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X , 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: 135990002 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".