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NPI Code Detail

MEDICARE: CHILD DEVELOPMENT SERVICES

MEDICARE: CHILD DEVELOPMENT SERVICES
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
1252Y00000XEarly Intervention Provider AgencyOT1774ME

General Provider Information

NPI Number : 1720217003
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHILD DEVELOPMENT SERVICES
Provider Business Mailing Address
First Line : 163 SILVER ST
Second Line :
City : WATERVILLE
State : ME
Zip : 04901-5813
Country : US
Telephone Number : 207-877-2498
Fax Number : 207-877-7459
Provider Business Practice Location Address
First Line : 163 SILVER ST
Second Line :
City : WATERVILLE
State : ME
Zip : 04901-5813
Country : US
Telephone Number : 207-877-2498
Fax Number : 207-877-7459
Authorized Official
Title or Position : SITE DIRECTOR
Name : MRS. ELIZABETH KEACH
Credential :
Telephone Number : 207-877-2498
Provider Enumeration Date : 07/08/2009
Last Update Date : 07/08/2009

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Directions to “CHILD DEVELOPMENT SERVICES ” Practice Location

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