MEDICARE: HEALTHREACH COMMUNITY HEALTH CENTERS

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	261QF0400X	Federally Qualified Health Center (FQHC)	E58728	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497729750
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHREACH COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 569
Second Line	:	42 DALLAS HILL ROAD
City	:	RANGELEY
State	:	ME
Zip	:	04970
Country	:	US
Telephone Number	:	207-864-3947
Fax Number	:	207-864-2969

Provider Business Practice Location Address
First Line	:	42 DALLAS HILL RD
Second Line	:
City	:	RANGELEY
State	:	ME
Zip	:	04970
Country	:	US
Telephone Number	:	207-864-3303
Fax Number	:	207-864-2969

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	CONSTANCE R COGGINS
Credential	:
Telephone Number	:	207-861-3407

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	07/07/2008

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