Healthcare Provider Details

I. General information

NPI: 1851539548
Provider Name (Legal Business Name): CHILD HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 MADISON AVE
OXFORD ME
04270-3579
US

IV. Provider business mailing address

16 MADISON AVE
OXFORD ME
04270-3579
US

V. Phone/Fax

Practice location:
  • Phone: 207-743-7035
  • Fax: 207-743-2970
Mailing address:
  • Phone: 207-743-7035
  • Fax: 207-743-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number210451
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number210451
License Number StateME

VIII. Authorized Official

Name: MR. RAYMOND R HATCH
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-743-7035