Healthcare Provider Details

I. General information

NPI: 1740340132
Provider Name (Legal Business Name): WOODFORDS FAMILY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAUNDERS WAY STE 700
WESTBROOK ME
04092-4834
US

IV. Provider business mailing address

15 SAUNDERS WAY STE 900
WESTBROOK ME
04092-4836
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-9663
  • Fax: 207-878-9663
Mailing address:
  • Phone: 207-878-9663
  • Fax: 207-878-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number494640
License Number StateME

VIII. Authorized Official

Name: JUDITH THIBODEAU
Title or Position: REVENUE MANAGER
Credential:
Phone: 207-878-9663