=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134200702
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALAIS COMMUNITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 07/30/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 PALMER ST
-----------------------------------------------------
City | CALAIS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04619-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-454-8150
-----------------------------------------------------
Fax | 207-454-0256
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 PALMER ST
-----------------------------------------------------
City | CALAIS
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04619-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-454-8150
-----------------------------------------------------
Fax | 207-454-0256
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | LYNNETTE PARR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-255-0269
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QR1300X
-----------------------------------------------------
Taxonomy Name | Rural Health Clinic/Center
-----------------------------------------------------
License Number | 208509
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------