1982709507 NPI number — THE PROGRESS CENTER, INC.

Table of content: (NPI 1982709507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982709507 NPI number — THE PROGRESS CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PROGRESS CENTER, INC.
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:
1982709507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 COTTAGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORWAY
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-743-8049
Provider Business Mailing Address Fax Number:
207-739-6110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 COTTAGE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORWAY
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04268
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-743-8049
Provider Business Practice Location Address Fax Number:
207-739-6110
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANTHONY
Authorized Official First Name:
DEB
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
207-743-8049

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: ALLS 2094 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: ALLS817 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320600000X , with the licence number: ALLS 627 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 110670203 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670101 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670201 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670400 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670300 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110670100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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