1730201898 NPI number — FACING CHANGE, PA

Table of content: (NPI 1730201898)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730201898 NPI number — FACING CHANGE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACING CHANGE, PA
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:
1730201898
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 PARK ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04240-7128
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-784-0922
Provider Business Mailing Address Fax Number:
207-784-6143

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4 PARK ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04240-7128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-784-0922
Provider Business Practice Location Address Fax Number:
207-784-6143
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUDWIG
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
207-784-0922

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  220581 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X , with the licence number: 221421 , 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: 09819655 . This is a "DIRIGO" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 129500000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: ME 0269 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 098156 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 103922 . This is a "NANCY'S # FOR MERIT B.C." identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 279870 . This is a "VALUE OPTIONS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: A391919 . This is a "GREAT WESTERN INSURANCE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 42678 . This is a "AGENCY # FOR MERIT B.C." identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 5202793 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: A511899180001 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 017366 . This is a "DIRIGO" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2015010 . This is a "NANCY'S # FOR B.H." identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 2118169 . This is a "BEHAVIORAL HEALTH FOR F.C" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 237557 . This is a "MAGELLAN'S # FOR NANCY" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 804560 . This is a "TUFTS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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