Healthcare Provider Details

I. General information

NPI: 1013141928
Provider Name (Legal Business Name): WASHINGTON COUNTY CHILDREN'S PROGRAM BOARD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2009
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 STEVE'S LANE
MARSHFIELD ME
04654-0000
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 Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number StateME

VIII. Authorized Official

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