Healthcare Provider Details

I. General information

NPI: 1598152035
Provider Name (Legal Business Name): MAINE COAST REGIONAL HEALTH FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 UNION ST
ELLSWORTH ME
04605-1534
US

IV. Provider business mailing address

50 UNION ST
ELLSWORTH ME
04605-1534
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-5304
  • Fax: 207-664-5305
Mailing address:
  • Phone: 207-664-5304
  • Fax: 207-664-5305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES D THERRIEN
Title or Position: CEO/PRESIDENT
Credential:
Phone: 207-664-5301