1770703597 NPI number — GOOD WILL HOME ASSOCIATION

Table of content: (NPI 1770703597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770703597 NPI number — GOOD WILL HOME ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD WILL HOME ASSOCIATION
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:
GOOD WILL-HINCKLEY
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:
1770703597
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HINCKLEY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04944-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-238-4000
Provider Business Mailing Address Fax Number:
207-238-4017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WATERVILLE RD
Provider Second Line Business Practice Location Address:
PRESCOTT ADMINISTRATION BLDG.
Provider Business Practice Location Address City Name:
HINCKLEY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04944-0159
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-238-4000
Provider Business Practice Location Address Fax Number:
207-238-4017
Provider Enumeration Date:
04/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COLAN
Authorized Official First Name:
NEIL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
207-238-4000

Provider Taxonomy Codes

  • Taxonomy code: 322D00000X , with the licence number:  PS885 , 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: 101810004 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810006 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810103 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810008 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810005 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810002 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810003 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810009 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431543400 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101810007 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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