Healthcare Provider Details

I. General information

NPI: 1023172145
Provider Name (Legal Business Name): IAM-3RIVERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 HILLSIDE RD
ORONO ME
04473-4459
US

IV. Provider business mailing address

PO BOX 1280
WESTBROOK ME
04098-1280
US

V. Phone/Fax

Practice location:
  • Phone: 207-866-3769
  • Fax: 207-866-3769
Mailing address:
  • Phone: 207-523-5170
  • Fax: 207-854-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number36469
License Number StateME

VIII. Authorized Official

Name: MS. ANN-MARIE MAYBERRY
Title or Position: CEO
Credential:
Phone: 207-831-1463