Healthcare Provider Details

I. General information

NPI: 1144468232
Provider Name (Legal Business Name): SOUTHERN KENNEBEC CHILD DEVELOPMENT CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2009
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 MAINE AVE
FARMINGDALE ME
04344-2900
US

IV. Provider business mailing address

337 MAINE AVE
FARMINGDALE ME
04344-2900
US

V. Phone/Fax

Practice location:
  • Phone: 207-582-3110
  • Fax: 207-582-3112
Mailing address:
  • Phone: 207-582-3110
  • Fax: 207-582-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MONIQUE MORIN
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 207-582-3110