Healthcare Provider Details

I. General information

NPI: 1093968943
Provider Name (Legal Business Name): YORK COUNTY COMMUNITY ACTION CORPS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2008
Last Update Date: 07/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MERRILL STREET
SPRINGVALE ME
04083
US

IV. Provider business mailing address

P.O. BOX 72
SANFORD ME
04073
US

V. Phone/Fax

Practice location:
  • Phone: 207-324-5762
  • Fax:
Mailing address:
  • Phone: 207-324-5762
  • Fax: 207-490-5026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier137930302
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name: THOMAS D NELSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 207-324-5762