MEDICARE: LABRECQUE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility

General Provider Information

NPI Number	:	1023242294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LABRECQUE HOME

Provider Business Mailing Address
First Line	:	PO BOX 649
Second Line	:
City	:	SANFORD
State	:	ME
Zip	:	04073-0649
Country	:	US
Telephone Number	:	207-793-8103
Fax Number	:	207-793-2408

Provider Business Practice Location Address
First Line	:	97 DEMERITT RD
Second Line	:
City	:	WEST NEWFIELD
State	:	ME
Zip	:	04095
Country	:	US
Telephone Number	:	207-793-8103
Fax Number	:	207-793-2408

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ROBERT JOSEPH LABRECQUE II
Credential	:
Telephone Number	:	207-793-8103

Provider Enumeration Date	:	05/04/2009
Last Update Date	:	05/04/2009

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Directions to “LABRECQUE HOME ” Practice Location

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