Healthcare Provider Details

I. General information

NPI: 1336352129
Provider Name (Legal Business Name): RSU 84
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31A HOULTON RD
DANFORTH ME
04424-3138
US

IV. Provider business mailing address

31A HOULTON RD
DANFORTH ME
04424-3138
US

V. Phone/Fax

Practice location:
  • Phone: 207-448-2882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier137800000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name: KIM ARMSTRONG
Title or Position: ADMINISTRATIVE ASSISTANT
Credential:
Phone: 207-448-7368