1962542092 NPI number — ALLEGIANCE HOSPICE CARE OF MAINE

Table of content: (NPI 1962542092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962542092 NPI number — ALLEGIANCE HOSPICE CARE OF MAINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLEGIANCE HOSPICE CARE OF MAINE
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:
1962542092
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
101 SUN AVENUE NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-468-5604
Provider Business Mailing Address Fax Number:
505-468-4681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FODEN ROAD WEST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SOUTH PORTLAND
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04106-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-761-6967
Provider Business Practice Location Address Fax Number:
207-772-6240
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CAVALLO
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
479-996-5900

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  37044 , 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: 432631300 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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