Healthcare Provider Details

I. General information

NPI: 1083889950
Provider Name (Legal Business Name): PERSONAL ONSITE DEVELOPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MANLEY RD
AUBURN ME
04210-3653
US

IV. Provider business mailing address

PO BOX 1507
LEWISTON ME
04241-1507
US

V. Phone/Fax

Practice location:
  • Phone: 207-753-3221
  • Fax: 207-753-3222
Mailing address:
  • Phone: 207-753-3221
  • Fax: 207-753-3222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DIANNE L COTE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-753-3221