Healthcare Provider Details

I. General information

NPI: 1841397932
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/13/2024
Certification Date: 10/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

IV. Provider business mailing address

118 NORTHPORT AVE
BELFAST ME
04915-6009
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-2500
  • Fax: 207-338-9368
Mailing address:
  • Phone: 207-338-2500
  • Fax: 207-338-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number36424
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number37189
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License Number37023
License Number StateME

VIII. Authorized Official

Name: LUGENE INZANA
Title or Position: ASSOCIATE CFO
Credential:
Phone: 207-662-2654