1073037099 NPI number — NEXT STEP DOMESTIC VIOLENCE PROJECT

Table of content: (NPI 1073037099)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073037099 NPI number — NEXT STEP DOMESTIC VIOLENCE PROJECT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEXT STEP DOMESTIC VIOLENCE PROJECT
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:
1073037099
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1466
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLSWORTH
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04605-1466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-667-0176
Provider Business Mailing Address Fax Number:
207-667-8033

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
733 BANGOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLSWORTH
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04605-3580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-667-0176
Provider Business Practice Location Address Fax Number:
207-667-8033
Provider Enumeration Date:
08/01/2017

Additional Information

Authorized Official

Authorized Official Last Name:
MARTELL
Authorized Official First Name:
DORATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
207-667-0176

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  XL-4560 , 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: XL-4560 . This is a "LCPC-C LICENSE NUMBER" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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