=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316176019
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRANKLIN COUNTY CHILDREN'S TASK FORCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2009
-----------------------------------------------------
Last Update Date | 07/02/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 113 CHURCH ST
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04938-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-778-6960
-----------------------------------------------------
Fax | 207-779-1029
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 113 CHURCH ST
-----------------------------------------------------
City | FARMINGTON
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04938-5900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-778-6960
-----------------------------------------------------
Fax | 207-779-1029
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | RENEE M BLANCHET
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 207-778-6960
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------