Healthcare Provider Details

I. General information

NPI: 1770848525
Provider Name (Legal Business Name): KENTS HILL SCHOOL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 MAIN ST
KENTS HILL ME
04349-3545
US

IV. Provider business mailing address

1614 MAIN ST
KENTS HILL ME
04349-3545
US

V. Phone/Fax

Practice location:
  • Phone: 207-685-4914
  • Fax: 207-685-9529
Mailing address:
  • Phone: 207-685-4914
  • Fax: 207-685-9529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARRY GATES
Title or Position: CFO
Credential:
Phone: 207-685-4914