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General NPI Number Information
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NPI Number | 1497810964
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Entity Type | Organization
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Legal Business Name | PEREGRINE CORPORATION
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 07/21/2009
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Provider Practice Location Address
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Address Line | 1011 FOREST AVENUE
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City | PORTLAND
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State | ME
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Zip | 04103
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Country | US
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Telephone | 207-879-0847
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Fax | 207-857-2919
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Provider Business Mailing Address
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Address Line | 1011 FOREST AVENUE
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City | PORTLAND
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State | ME
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Zip | 04103
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Country | US
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Telephone | 207-879-0847
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Fax | 207-857-2919
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | CAROL A. PAPCIAK
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Credential |
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Telephone | 207-879-0847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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