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General NPI Number Information
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NPI Number | 1104203652
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Entity Type | Organization
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Legal Business Name | SACO SPORT & FITNESS
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Dates
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Enumeration Date | 05/05/2015
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Last Update Date | 05/05/2015
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Provider Practice Location Address
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Address Line | 329 NORTH ST
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City | SACO
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State | ME
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Zip | 04072-1815
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Country | US
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Telephone | 207-284-5953
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Fax | 207-284-6635
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Provider Business Mailing Address
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Address Line | 329 NORTH ST
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City | SACO
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State | ME
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Zip | 04072-1815
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Country | US
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Telephone | 207-284-5953
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Fax | 207-284-6635
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Authorized Official
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Title or Position | PRESIDENT
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Name | SCOTT GILLESPIE
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Credential |
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Telephone | 207-284-5953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State |
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