1568854321 NPI number — WATERS EDGE THERAPY, INC.

Table of content: (NPI 1568854321)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568854321 NPI number — WATERS EDGE THERAPY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WATERS EDGE THERAPY, 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:
1568854321
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8 WATER ST
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04963-4956
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-530-0880
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8 WATER ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04963-4956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-530-0880
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HOWARD-MORAND
Authorized Official First Name:
DIANNE
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CLINICAL DIRECTOR
Authorized Official Telephone Number:
207-530-0880

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , 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: 1356619670 . This is a "MAINE CARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "MEDICARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "MAINE COMMUNITY HEALTH OPTIONS" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "APS HEALTHCARE" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "ANTHEM" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "MARTINS POINT" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "CHAMP VA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1356619670 . This is a "CAQH 12661845" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".




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