Healthcare Provider Details

I. General information

NPI: 1679775456
Provider Name (Legal Business Name): RESIDENTIAL RESOURCES OF MAINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 02/13/2020
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SUMMER ST
KEENE NH
03431
US

IV. Provider business mailing address

39 SUMMER ST
KEENE NH
03431-3318
US

V. Phone/Fax

Practice location:
  • Phone: 800-287-2911
  • Fax: 844-281-0423
Mailing address:
  • Phone: 800-287-2911
  • Fax: 844-281-0423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateME
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER BERTONCINI
Title or Position: CFO
Credential:
Phone: 800-287-2911