MEDICARE: LOUISE M LABRECQUE

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	253J00000X	Foster Care Agency	6656071	ME

General Provider Information

NPI Number	:	1073822631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOUISE M LABRECQUE

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 ROAD
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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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Directions to “ LOUISE M LABRECQUE ” Practice Location

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