MEDICARE: MRS. JULIE M, SMITH

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	ALLS2153	ME

General Provider Information

NPI Number	:	1376756361
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JULIE M, SMITH

Provider Business Mailing Address
First Line	:	802 AUGUSTA RD
Second Line	:
City	:	ROME
State	:	ME
Zip	:	04963-3137
Country	:	US
Telephone Number	:	207-397-2131
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 AUGUSTA RD
Second Line	:
City	:	ROME
State	:	ME
Zip	:	04963-3137
Country	:	US
Telephone Number	:	207-397-2131
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	07/09/2007

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