Healthcare Provider Details

I. General information

NPI: 1780615492
Provider Name (Legal Business Name): CITY OF CARIBOU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VAN BUREN RD
CARIBOU ME
04736-3567
US

IV. Provider business mailing address

163 VAN BUREN RD
CARIBOU ME
04736-3567
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-3111
  • Fax: 207-496-2631
Mailing address:
  • Phone: 207-498-3111
  • Fax: 207-496-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number36719
License Number StateME

VIII. Authorized Official

Name: MS. KRIS A DOODY
Title or Position: CHEIF EXECUTIVE OFFICER
Credential:
Phone: 207-498-1181