Healthcare Provider Details

I. General information

NPI: 1780828285
Provider Name (Legal Business Name): WINNIE THE POOH NURSERY SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2009
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 CENTER ST
BANGOR ME
04401-5003
US

IV. Provider business mailing address

56 CENTER ST
BANGOR ME
04401-5003
US

V. Phone/Fax

Practice location:
  • Phone: 207-947-2579
  • Fax:
Mailing address:
  • Phone: 207-947-2579
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number2124111
License Number StateME

VIII. Authorized Official

Name: CARRIE B ANDERSON
Title or Position: DIRECTOR
Credential:
Phone: 207-947-2579