Healthcare Provider Details

I. General information

NPI: 1164496410
Provider Name (Legal Business Name): HEALTHREACH COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2006
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 GARDINER ST
RICHMOND ME
04357-1336
US

IV. Provider business mailing address

24 GARDINER ST
RICHMOND ME
04357-1336
US

V. Phone/Fax

Practice location:
  • Phone: 207-737-4359
  • Fax: 207-737-4412
Mailing address:
  • Phone: 207-737-4359
  • Fax: 207-737-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License NumberE58728
License Number StateME

VIII. Authorized Official

Name: KATE A QUIMBY
Title or Position: INSURANCE CREDENTIALING COORDINATOR
Credential:
Phone: 207-864-2699