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General NPI Number Information
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NPI Number | 1699776146
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Entity Type | Organization
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Legal Business Name | STATE OF MAINE
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Dates
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Enumeration Date | 08/09/2005
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Last Update Date | 06/17/2019
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Provider Practice Location Address
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Address Line | 656 STATE ST
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City | BANGOR
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State | ME
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Zip | 04401-5609
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Country | US
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Telephone | 207-941-4192
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Fax |
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Provider Business Mailing Address
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Address Line | 109 CAPITOL STREET STATE HOUSE STATION #11, REIMBURSEMENT UNIT
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City | AUGUSTA
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State | ME
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Zip | 04330-6846
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Country | US
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Telephone | 207-287-7418
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Fax | 207-287-1862
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Authorized Official
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Title or Position | FINANCIAL MANAGER
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Name | CAROL WEBB CODY
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Credential |
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Telephone | 207-941-4192
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283Q00000X
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Taxonomy Name | Psychiatric Hospital
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License Number |
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License Number State |
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