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General NPI Number Information
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NPI Number | 1104201938
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Entity Type | Organization
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Legal Business Name | DEVOTED SUPPORTS OF MAINE
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 07/22/2015
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Provider Practice Location Address
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Address Line | 304 HANCOCK ST STE 1E
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City | BANGOR
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State | ME
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Zip | 04401-6573
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Country | US
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Telephone | 207-992-9587
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Fax |
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Provider Business Mailing Address
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Address Line | 304 HANCOCK ST STE 1E
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City | BANGOR
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State | ME
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Zip | 04401-6573
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Country | US
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Telephone | 207-992-9587
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN MICHAEL JONES
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Credential | MBA
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Telephone | 207-299-7677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | ME
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