Healthcare Provider Details

I. General information

NPI: 1992483481
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 FRANKLIN HEALTH CMNS
FARMINGTON ME
04938-6144
US

IV. Provider business mailing address

111 FRANKLIN HEALTH CMNS
FARMINGTON ME
04938-6144
US

V. Phone/Fax

Practice location:
  • Phone: 207-779-2048
  • Fax: 207-779-2662
Mailing address:
  • Phone: 207-779-2048
  • Fax: 207-779-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: CFO & MH ASSOCIATE CFO
Credential:
Phone: 207-662-2654