Healthcare Provider Details

I. General information

NPI: 1013960673
Provider Name (Legal Business Name): MONMOUTH RESCUE ASSOCIATION, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 02/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 MAIN ST
MONMOUTH ME
04259
US

IV. Provider business mailing address

PO BOX 1810
WINDHAM ME
04062-1810
US

V. Phone/Fax

Practice location:
  • Phone: 207-933-2615
  • Fax: 207-933-6458
Mailing address:
  • Phone: 207-892-0020
  • Fax: 207-893-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number473
License Number StateME

VIII. Authorized Official

Name: STEPHEN F HARRISON
Title or Position: CHIEF OF SERVICE
Credential:
Phone: 207-933-6727