Healthcare Provider Details

I. General information

NPI: 1518541481
Provider Name (Legal Business Name): YORK COUNTY COMMUNITY ACTION CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 06/19/2021
Certification Date: 06/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 OAK ST
SPRINGVALE ME
04083-1926
US

IV. Provider business mailing address

PO BOX 72
SANFORD ME
04073-0072
US

V. Phone/Fax

Practice location:
  • Phone: 207-490-6900
  • Fax: 207-324-0546
Mailing address:
  • Phone: 207-490-6900
  • Fax: 207-324-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DIANE LAURENDEAU
Title or Position: CFO
Credential:
Phone: 207-324-5762