Healthcare Provider Details

I. General information

NPI: 1477781326
Provider Name (Legal Business Name): JOHANN PINKERTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 GRANITE ST
MEXICO ME
04257-1622
US

IV. Provider business mailing address

130 GRANITE ST
MEXICO ME
04257-1622
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-3124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: JOHANN PINKERTON
Title or Position: OWNER
Credential:
Phone: 207-364-3124