Healthcare Provider Details

I. General information

NPI: 1720214950
Provider Name (Legal Business Name): JMPB INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 BENTON AVE
BENTON ME
04901-3327
US

IV. Provider business mailing address

PO BOX 358
FAIRFIELD ME
04937-0358
US

V. Phone/Fax

Practice location:
  • Phone: 207-453-4708
  • Fax: 207-453-6250
Mailing address:
  • Phone: 207-453-4708
  • Fax: 207-453-6250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number406317
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number406317
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number02971
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number406317
License Number StateME
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number02971
License Number StateME

VIII. Authorized Official

Name: MRS. JOHNNA MARIE BOWEN
Title or Position: CEO
Credential: RN
Phone: 207-453-4708