Healthcare Provider Details

I. General information

NPI: 1508782848
Provider Name (Legal Business Name): CITY OF ELLSWORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 LEJOK ST
ELLSWORTH ME
04605-4767
US

IV. Provider business mailing address

11 AVERY LN
ELLSWORTH ME
04605-2531
US

V. Phone/Fax

Practice location:
  • Phone: 207-664-7100
  • Fax:
Mailing address:
  • Phone: 207-664-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: AMY BOLES
Title or Position: SUPERINTENDENT OF SCHOOLS
Credential:
Phone: 207-664-7100