1851897193 NPI number — JULIE RACINE, INC

Table of content: (NPI 1851897193)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851897193 NPI number — JULIE RACINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE RACINE, 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:
1851897193
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 158
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04776-0158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
226 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04776-3064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-365-9932
Provider Business Practice Location Address Fax Number:
207-433-1131
Provider Enumeration Date:
04/04/2018

Additional Information

Authorized Official

Authorized Official Last Name:
RACINE
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PMHNP-BC
Authorized Official Telephone Number:
207-447-1396

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , 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: 1598964405 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com