Healthcare Provider Details

I. General information

NPI: 1811917222
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 JUNE ST
SANFORD ME
04073-2621
US

IV. Provider business mailing address

22 BRAMHALL ST ATTN CASHIERS OFFICE
PORTLAND ME
04102-3134
US

V. Phone/Fax

Practice location:
  • Phone: 207-283-7460
  • Fax: 207-662-6234
Mailing address:
  • Phone: 207-662-6562
  • Fax: 207-662-6234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number36236
License Number StateME

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: CFO & ASSOCIATE CFO
Credential:
Phone: 207-662-3538