Healthcare Provider Details

I. General information

NPI: 1609137843
Provider Name (Legal Business Name): ACCESS HEALTH RENEWAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 SO. FREEPORT ROAD SUITE 2A
FREEPORT ME
04032
US

IV. Provider business mailing address

174 SO. FREEPORT ROAD SUITE 2A
FREEPORT ME
04032
US

V. Phone/Fax

Practice location:
  • Phone: 207-865-5520
  • Fax: 866-270-1070
Mailing address:
  • Phone: 207-865-5520
  • Fax: 866-270-1070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ARIEL E. WILCOX
Title or Position: PRESIDENT
Credential:
Phone: 207-865-5520