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General NPI Number Information
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NPI Number | 1760618235
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Entity Type | Organization
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Legal Business Name | TEEN AND YOUNG PARENT PROGRAM OF KNOX COUNTY, INC.
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Dates
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Enumeration Date | 06/10/2009
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 231B PARK ST
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City | ROCKLAND
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State | ME
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Zip | 04841-2127
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Country | US
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Telephone | 207-594-1980
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Fax | 207-594-7682
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Provider Business Mailing Address
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Address Line | PO BOX 805
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City | ROCKLAND
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State | ME
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Zip | 04841-0805
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Country | US
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Telephone | 207-594-1980
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Fax | 207-594-7682
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Authorized Official
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Title or Position | PRESIDENT OF THE BOARD OF DIRECTORS
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Name | MS. SANDRA LOWE
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Credential |
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Telephone | 207-594-1980
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 432848100
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License Number State |
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