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General NPI Number Information
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NPI Number | 1811917222
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Entity Type | Organization
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Legal Business Name | MAINEHEALTH
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 08/28/2024
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Provider Practice Location Address
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Address Line | 25 JUNE ST
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City | SANFORD
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State | ME
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Zip | 04073-2621
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Country | US
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Telephone | 207-283-7460
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Fax | 207-662-6234
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Provider Business Mailing Address
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Address Line | 22 BRAMHALL ST ATTN CASHIERS OFFICE
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City | PORTLAND
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State | ME
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Zip | 04102-3134
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Country | US
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Telephone | 207-662-6562
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Fax | 207-662-6234
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Authorized Official
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Title or Position | CFO & ASSOCIATE CFO
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Name | LUGENE ANTHONY INZANA
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Credential |
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Telephone | 207-662-3538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 36236
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License Number State | ME
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