Healthcare Provider Details

I. General information

NPI: 1043442320
Provider Name (Legal Business Name): WASHINGTON COUNTY CHILDREN'S PROGRAM BRD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 STEVES LANE
MARSHFIELD ME
04654
US

IV. Provider business mailing address

PO BOX 311
MACHIAS ME
04654-0311
US

V. Phone/Fax

Practice location:
  • Phone: 207-255-3426
  • Fax: 207-255-3426
Mailing address:
  • Phone: 207-255-3426
  • Fax: 207-255-3426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number2212
License Number StateME

VIII. Authorized Official

Name: ELAINE CALE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-255-3426