Healthcare Provider Details

I. General information

NPI: 1578753836
Provider Name (Legal Business Name): JADE TRADE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 WASHINGTON AVE
PORTLAND ME
04103-2793
US

IV. Provider business mailing address

1023 WASHINGTON AVE
PORTLAND ME
04103-2793
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-5778
  • Fax: 207-773-5773
Mailing address:
  • Phone: 207-773-5778
  • Fax: 207-773-5773

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC200
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT1458
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2432
License Number State

VIII. Authorized Official

Name: KESIA CAMPBELL
Title or Position: BILLING SPECIALIST
Credential:
Phone: 207-747-5746