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General NPI Number Information
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NPI Number | 1063652832
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Entity Type | Organization
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Legal Business Name | SARA L. HOLMES
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/12/2009
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Provider Practice Location Address
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Address Line | 651 B RD
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City | HOULTON
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State | ME
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Zip | 04730-3722
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Country | US
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Telephone | 207-532-9214
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Fax |
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Provider Business Mailing Address
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Address Line | 651 B RD
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City | HOULTON
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State | ME
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Zip | 04730-3722
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Country | US
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Telephone | 207-532-9214
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | MRS. SARA L HOLMES
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Credential |
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Telephone | 207-532-9214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 433035000
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License Number State | ME
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