Healthcare Provider Details

I. General information

NPI: 1497957021
Provider Name (Legal Business Name): UCP OF NORTHEASTERN MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOUNT HOPE AVE STE 320
BANGOR ME
04401-5680
US

IV. Provider business mailing address

700 MOUNT HOPE AVE STE 320
BANGOR ME
04401-5680
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-2952
  • Fax: 207-941-2955
Mailing address:
  • Phone: 207-941-2952
  • Fax: 207-941-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number209700
License Number StateME

VIII. Authorized Official

Name: BOBBI-JO YEAGER
Title or Position: EXECUTICE DIRECTOR
Credential:
Phone: 207-941-2952