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General NPI Number Information
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NPI Number | 1437295359
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Entity Type | Organization
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Legal Business Name | GREEN VALLEY ASSOCIATION
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 01/12/2009
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Provider Practice Location Address
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Address Line | 13 GARDNER STREET
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City | PATTEN
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State | ME
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Zip | 04765
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Country | US
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Telephone | 207-528-2064
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Fax | 207-463-2151
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Provider Business Mailing Address
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Address Line | PO BOX 127
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City | ISLAND FALLS
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State | ME
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Zip | 04747-0127
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Country | US
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Telephone | 207-463-2156
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Fax | 207-463-2151
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | ERIC C. QUINT
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Credential |
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Telephone | 207-463-2156
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | ALLS 2244
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License Number State | ME
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