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General NPI Number Information
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NPI Number | 1710124599
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Entity Type | Organization
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Legal Business Name | WILLIAM MIRO,
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Dates
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Enumeration Date | 01/15/2009
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Last Update Date | 08/28/2009
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Provider Practice Location Address
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Address Line | 636 US ROUTE 1
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9700
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Country | US
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Telephone | 207-883-2611
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Fax | 207-883-2611
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Provider Business Mailing Address
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Address Line | 31 OLD BLUE POINT RD
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City | SCARBOROUGH
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State | ME
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Zip | 04074-9608
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Country | US
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Telephone | 207-883-2611
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Fax | 207-883-8611
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Authorized Official
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Title or Position | DIRECTOR OF SERVICES
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Name | WILLIAM VINCENT MIRO
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Credential |
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Telephone | 207-883-2611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320600000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Residential Treatment Facility
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License Number | 320600000X
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License Number State | ME
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