MEDICARE: PINE TREE COMMUINTY SERVICES, LLC

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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1205228590
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PINE TREE COMMUINTY SERVICES, LLC

Provider Business Mailing Address
First Line	:	171 WARREN AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1103
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	171 WARREN AVE
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04103-1103
Country	:	US
Telephone Number	:	207-253-9000
Fax Number	:

Authorized Official
Title or Position	:	C.E.O
Name	:	MR. MOHAMMED JABER
Credential	:
Telephone Number	:	207-253-9000

Provider Enumeration Date	:	02/24/2015
Last Update Date	:	02/24/2015

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Directions to “PINE TREE COMMUINTY SERVICES, LLC ” Practice Location

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