1366506347 NPI number — BORDERVIEW HOLDINGS CORP

Table of content: (NPI 1366506347)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366506347 NPI number — BORDERVIEW HOLDINGS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BORDERVIEW HOLDINGS CORP
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:
6
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:
1366506347
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1408
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISTON
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04243-1408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-786-3554
Provider Business Mailing Address Fax Number:
207-786-8507

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAN BUREN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04785-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-868-5211
Provider Business Practice Location Address Fax Number:
207-868-3579
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CYR
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
207-786-3554

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2061 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 2061 , 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: 134290000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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