Healthcare Provider Details

I. General information

NPI: 1104005362
Provider Name (Legal Business Name): SPURWINK SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

778 MAIN ST
SOUTH PORTLAND ME
04106-5447
US

IV. Provider business mailing address

901 WASHINGTON AVE STE 100
PORTLAND ME
04103-2842
US

V. Phone/Fax

Practice location:
  • Phone: 207-879-6160
  • Fax: 207-871-5668
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number229881
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number229881
License Number StateME

VIII. Authorized Official

Name: ERIC MEYER
Title or Position: PRESIDENT
Credential: LCSW
Phone: 207-871-1200