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General NPI Number Information
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NPI Number | 1912233826
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Entity Type | Organization
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Legal Business Name | MERRIMACK RIVER MEDICAL SERVICES, INC.
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Dates
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Enumeration Date | 10/28/2009
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Last Update Date | 07/29/2024
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Provider Practice Location Address
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Address Line | 2300 CONGRESS ST
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City | PORTLAND
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State | ME
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Zip | 04102-1908
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Country | US
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Telephone | 207-221-2292
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Fax | 207-221-2297
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Provider Business Mailing Address
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Address Line | 1720 LAKEPOINTE DR
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City | LEWISVILLE
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State | TX
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Zip | 75057-6458
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Country | US
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Telephone | 214-379-3300
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Fax | 214-853-9018
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Authorized Official
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Title or Position | VP, TREASURER
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Name | BRUCE JARVIE
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Credential |
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Telephone | 214-379-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2800X
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Taxonomy Name | Methadone Clinic
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number |
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License Number State |
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