Healthcare Provider Details

I. General information

NPI: 1053481747
Provider Name (Legal Business Name): AROOSTOOK COUNTY ACTION PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 MAIN ST
PRESQUE ISLE ME
04769-2201
US

IV. Provider business mailing address

PO BOX 1116
PRESQUE ISLE ME
04769-1116
US

V. Phone/Fax

Practice location:
  • Phone: 207-768-3026
  • Fax: 207-768-3066
Mailing address:
  • Phone: 207-768-3026
  • Fax: 207-768-3066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDA MOUNTAIN
Title or Position: CLINIC COORDINATOR
Credential:
Phone: 207-768-3026