1770955783 NPI number — MOUNT DESERT NURSING ASSOCIATION

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770955783 NPI number — MOUNT DESERT NURSING ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOUNT DESERT NURSING 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:
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:
1770955783
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 397
Provider Second Line Business Mailing Address:
12 SUMMIT ROAD
Provider Business Mailing Address City Name:
NORTHEAST HARBOR
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04662-0397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-276-5184
Provider Business Mailing Address Fax Number:
207-276-5185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12 SUMMIT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHEAST HARBOR
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04662
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-276-5184
Provider Business Practice Location Address Fax Number:
207-276-5185
Provider Enumeration Date:
10/29/2015

Additional Information

Authorized Official

Authorized Official Last Name:
FUERST
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/TREASURER
Authorized Official Telephone Number:
207-276-5184

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  38238 , 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)





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