Healthcare Provider Details

I. General information

NPI: 1346706629
Provider Name (Legal Business Name): CALAIS REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2019
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BOYNTON ST
EASTPORT ME
04631-1306
US

IV. Provider business mailing address

24 HOSPITAL LN
CALAIS ME
04619-1329
US

V. Phone/Fax

Practice location:
  • Phone: 207-454-7521
  • Fax:
Mailing address:
  • Phone: 207-454-7521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARY BARNETT
Title or Position: COMPLIANCE OFFICER
Credential:
Phone: 207-454-9253