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General NPI Number Information
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NPI Number | 1609917889
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Entity Type | Organization
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Legal Business Name | CITY OF PORTLAND
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 1145 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-1025
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Country | US
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Telephone | 207-541-6500
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Fax | 207-541-6555
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Provider Business Mailing Address
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Address Line | 1145 BRIGHTON AVE
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City | PORTLAND
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State | ME
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Zip | 04102-1025
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Country | US
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Telephone | 207-541-6500
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Fax | 207-541-6555
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Authorized Official
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Title or Position | FINANCE ADMINISTRATOR
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Name | MRS. JERALYN P LOGUE
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Credential |
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Telephone | 207-541-6544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311Z00000X
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Taxonomy Name | Custodial Care Facility
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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 | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 36498
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License Number State | ME
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