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General NPI Number Information
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NPI Number | 1730350588
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Entity Type | Organization
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Legal Business Name | MID MAINE HOMELESS SHELTER
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Dates
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Enumeration Date | 03/20/2008
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Last Update Date | 03/20/2008
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Provider Practice Location Address
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Address Line | 28 TICONIC STREET
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City | WATERVILLE
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State | ME
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Zip | 04903-2612
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Country | US
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Telephone | 207-872-8082
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Fax | 207-872-6550
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Provider Business Mailing Address
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Address Line | PO BOX 2612
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City | WATERVILLE
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State | ME
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Zip | 04903-2612
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Country | US
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Telephone | 207-872-8082
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Fax | 207-872-6550
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MIKE MARSTON
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Credential |
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Telephone | 207-872-8082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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