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NPI Code Detail

MEDICARE: SULLIVAN CENTER, INC

MEDICARE: SULLIVAN CENTER, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1689829053
Entity Type Code : Organization
Provider Name (Legal Business Name) : SULLIVAN CENTER, INC
Provider Business Mailing Address
First Line : 895 PORTLAND RD
Second Line :
City : SACO
State : ME
Zip : 04072-9673
Country : US
Telephone Number : 207-571-9329
Fax Number : 207-571-9328
Provider Business Practice Location Address
First Line : 895 PORTLAND RD
Second Line :
City : SACO
State : ME
Zip : 04072-9673
Country : US
Telephone Number : 207-571-9329
Fax Number : 207-571-9328
Authorized Official
Title or Position : OWNER
Name : TAMERA AHEARN
Credential :
Telephone Number : 207-571-9329
Provider Enumeration Date : 11/26/2008
Last Update Date : 03/20/2009

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Directions to “SULLIVAN CENTER, INC ” Practice Location

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