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General NPI Number Information
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NPI Number | 1275439879
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Entity Type | Organization
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Legal Business Name | KATAHDIN RECOVERY & WELLNESS
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Dates
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Enumeration Date | 10/19/2026
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Last Update Date | 10/19/2026
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Provider Practice Location Address
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Address Line | 1928 MEDWAY RD UNIT 3
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City | MEDWAY
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State | ME
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Zip | 04460-3166
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Country | US
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Telephone | 207-447-2961
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Fax |
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Provider Business Mailing Address
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Address Line | 50 CRESTMONT AVE # 04462
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City | MILLINOCKET
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State | ME
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Zip | 04462-1906
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Country | US
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Telephone | 207-504-0588
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Fax |
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Authorized Official
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Title or Position | OWNER, NURSE PRACTITIONER
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Name | SAMANTHA JO DOE
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Credential | FNP, PMHNP
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Telephone | 207-504-0588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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