1063677722 NPI number — CHOICES

Table of content: (NPI 1063677722)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063677722 NPI number — CHOICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICES
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:
Provider Other Organization Name Type Code:
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:
1063677722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 316
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORINTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04427-0316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-285-0133
Provider Business Mailing Address Fax Number:
207-285-0190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
263 MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 1 VILLAGE DRIVE ESTATES
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04427-0316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-285-0133
Provider Business Practice Location Address Fax Number:
207-285-0190
Provider Enumeration Date:
07/22/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PLANTE
Authorized Official First Name:
LONNIE
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
ASSISTANT DIRECTOR
Authorized Official Telephone Number:
207-285-0133

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , with the licence number:  211962 , 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: 128350000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com