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	:	1568435345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEALTHREACH COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 1367
Second Line	:	32 RAILROAD ST
City	:	BETHEL
State	:	ME
Zip	:	04217-1367
Country	:	US
Telephone Number	:	207-824-2193
Fax Number	:	207-824-3138

Provider Business Practice Location Address
First Line	:	32 RAILROAD ST
Second Line	:
City	:	BETHEL
State	:	ME
Zip	:	04217-1367
Country	:	US
Telephone Number	:	207-824-2193
Fax Number	:	207-824-3138

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	CONSTANCE R COGGINS
Credential	:
Telephone Number	:	207-872-5610

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	11/10/2014

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