Healthcare Provider Details

I. General information

NPI: 1447342209
Provider Name (Legal Business Name): MAINEHEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 JULY STREET
SANFORD ME
04073
US

IV. Provider business mailing address

ONE MEDICAL CENTER DRIVE
BIDDEFORD ME
04005
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-7600
  • Fax: 207-490-7642
Mailing address:
  • Phone: 207-283-7000
  • Fax: 207-283-7063

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2031
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number#2787
License Number StateME

VIII. Authorized Official

Name: LUGENE ANTHONY INZANA
Title or Position: SVP FINANCE, CFO
Credential:
Phone: 207-662-3538