1487807764 NPI number — BRITTANY BH BALLARD MHRT-CSP

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 1487807764 NPI number — BRITTANY BH BALLARD MHRT-CSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALLARD
Provider First Name:
BRITTANY
Provider Middle Name:
BH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHRT-CSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HAINES
Provider Other First Name:
BRITTANY
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487807764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 HATCH DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARIBOU
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04736-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-498-6431
Provider Business Mailing Address Fax Number:
207-492-3181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
43 HATCH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARIBOU
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04736-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-498-6431
Provider Business Practice Location Address Fax Number:
207-492-3181
Provider Enumeration Date:
10/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , 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: 103850000 . This is a "MAINECARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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