1922170901 NPI number — EASTER SEALS MAINE, INC

Table of content: (NPI 1922170901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922170901 NPI number — EASTER SEALS MAINE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS MAINE, 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:
1922170901
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
555 AUBURN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03103-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-623-8863
Provider Business Mailing Address Fax Number:
603-622-8101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14 ATLANTIC PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-560-2894
Provider Business Practice Location Address Fax Number:
207-773-1139
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TREANOR
Authorized Official First Name:
ELIN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
603-621-3462

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 191720000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 191720001 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0921635002 . This is a "CIGNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 1341145 . This is a "AETNA" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 191720100 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: AA16930 . This is a "HARVARD PILGRIM HEALTHCAR" identifier , issued by the state of ( ME ) . This identifiers is of the category "OTHER".
  • Identifier: 191720200 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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