Healthcare Provider Details

I. General information

NPI: 1992943542
Provider Name (Legal Business Name): WESTERN MAINE COMMUNITY ACTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2009
Last Update Date: 02/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 PENOBSCOT ST
RUMFORD ME
04276-1914
US

IV. Provider business mailing address

21A CHURCH STREET
EAST WILTON ME
04234
US

V. Phone/Fax

Practice location:
  • Phone: 207-364-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0050X
TaxonomyNon-Surgical Family Planning Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH GERRY
Title or Position: DIRECTOR FINANCE & ADMINISTRATION
Credential:
Phone: 207-645-3764