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General NPI Number Information
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NPI Number | 1003173972
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Entity Type | Organization
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Legal Business Name | PAT CHANTERELLE LLC
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Dates
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Enumeration Date | 04/17/2012
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Last Update Date | 07/10/2012
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Provider Practice Location Address
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Address Line | 30 FOREST FALLS DR SUITE 1
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City | YARMOUTH
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State | ME
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Zip | 04096-6983
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Country | US
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Telephone | 207-846-7711
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Fax | 207-846-7711
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Provider Business Mailing Address
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Address Line | 30 FOREST FALLS DR SUITE 1
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City | YARMOUTH
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State | ME
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Zip | 04096-6983
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Country | US
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Telephone | 207-846-7711
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Fax | 207-846-7711
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PATRICIA CHANTERELLE
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Credential | D.C.
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Telephone | 207-846-7711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 284300000X
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Taxonomy Name | Special Hospital
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License Number | CR601
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License Number State | ME
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