Healthcare Provider Details

I. General information

NPI: 1619651213
Provider Name (Legal Business Name): BORDEN COTTAGE TREATMENT FACILITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 BAY VIEW ST
CAMDEN ME
04843-2251
US

IV. Provider business mailing address

PO BOX 799
CAMDEN ME
04843-0799
US

V. Phone/Fax

Practice location:
  • Phone: 207-236-3595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: TOM RODMAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 207-236-3595