Healthcare Provider Details

I. General information

NPI: 1881714491
Provider Name (Legal Business Name): SANDCASTLE PRESCHOOL PROGRAM FOUNDATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 STRAWBERRY AVE
LEWISTON ME
04240-5952
US

IV. Provider business mailing address

72 STRAWBERRY AVE
LEWISTON ME
04240-5952
US

V. Phone/Fax

Practice location:
  • Phone: 207-782-2150
  • Fax: 207-782-3621
Mailing address:
  • Phone: 207-782-2150
  • Fax: 207-782-3621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number215544
License Number StateME

VIII. Authorized Official

Name: MRS. STEPHANIE GELINAS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.S,CCC-SLP
Phone: 207-782-2150