Healthcare Provider Details

I. General information

NPI: 1427145358
Provider Name (Legal Business Name): MAINEGENERAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/16/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 WATER ST STE 307
WATERVILLE ME
04901-6566
US

IV. Provider business mailing address

10 WATER ST STE 307
WATERVILLE ME
04901-6566
US

V. Phone/Fax

Practice location:
  • Phone: 207-861-6200
  • Fax: 207-861-6297
Mailing address:
  • Phone: 207-861-6200
  • Fax: 207-861-6297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number36435
License Number StateME

VIII. Authorized Official

Name: GILLIAN FITZGERALD-CROSBY
Title or Position: DIRECTOR OF REVENUE CYCLE
Credential:
Phone: 207-621-3781