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General NPI Number Information
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NPI Number | 1740519057
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Entity Type | Organization
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Legal Business Name | MAS MEDICAL STAFFING CORPORATION
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Dates
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Enumeration Date | 12/15/2009
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Last Update Date | 01/30/2014
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Provider Practice Location Address
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Address Line | 30 SUMMER ST SUITE 5
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City | BANGOR
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State | ME
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Zip | 04401-6467
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Country | US
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Telephone | 207-561-9533
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Fax | 207-561-9538
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Provider Business Mailing Address
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Address Line | 156 HARVEY RD
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City | LONDONDERRY
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State | NH
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Zip | 03053-7449
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Country | US
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Telephone | 603-232-0972
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEN C JOHNSON
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Credential |
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Telephone | 603-232-0972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 37952
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License Number State | ME
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