Healthcare Provider Details

I. General information

NPI: 1013987684
Provider Name (Legal Business Name): WOODFORDS CONGREGATIONAL CHURCH, U.C.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 WOODFORD ST
PORTLAND ME
04103-5602
US

IV. Provider business mailing address

202 WOODFORD ST
PORTLAND ME
04103-5602
US

V. Phone/Fax

Practice location:
  • Phone: 207-774-8243
  • Fax: 207-773-3317
Mailing address:
  • Phone: 207-774-8243
  • Fax: 207-773-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: DONALD GENE HODGSON
Title or Position: PASTORAL COUNSELOR
Credential: D.MIN. (PSYCH)
Phone: 207-774-8243