Healthcare Provider Details

I. General information

NPI: 1063816189
Provider Name (Legal Business Name): RANGELEY REGION HEALTH AND WELLNESS PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 DALLAS HILL ROAD
RANGELEY ME
04970-0722
US

IV. Provider business mailing address

PO BOX 722 25 DALLAS HILL RD
RANGELEY ME
04970-0722
US

V. Phone/Fax

Practice location:
  • Phone: 207-864-4397
  • Fax: 207-864-9062
Mailing address:
  • Phone: 207-864-4397
  • Fax: 207-864-9062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. JEANNE THORVALDSEN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-864-4397