Healthcare Provider Details

I. General information

NPI: 1396889374
Provider Name (Legal Business Name): MILESTONE RECOVERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 10/22/2023
Certification Date: 10/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 INDIA ST
PORTLAND ME
04101-4209
US

IV. Provider business mailing address

28 PORTLAND ST
PORTLAND ME
04101-1990
US

V. Phone/Fax

Practice location:
  • Phone: 207-775-4790
  • Fax:
Mailing address:
  • Phone: 207-775-4790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number238672
License Number StateME

VIII. Authorized Official

Name: MR. THOMAS DOHERTY
Title or Position: EXECUTIVE DIRECTOR
Credential: MSW
Phone: 207-775-4790