1023082385 NPI number — HEALTHREACH COMMUNITY HEALTH CENTERS

Table of content: (NPI 1023082385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023082385 NPI number — HEALTHREACH COMMUNITY HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHREACH COMMUNITY HEALTH CENTERS
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:
MT ABRAM REGIONAL HEALTH CENTER
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:
1023082385
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 DEPOT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGFIELD
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04947-4208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-265-4555
Provider Business Mailing Address Fax Number:
207-265-5004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 DEPOT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINGFIELD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04947-4208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-265-4555
Provider Business Practice Location Address Fax Number:
207-265-5004
Provider Enumeration Date:
02/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
COGGINS
Authorized Official First Name:
CONSTANCE
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
207-872-5610

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , with the licence number:  E58728 , 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: 137970102 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com