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NPI Code Detail

MEDICARE: CHARLOTTE WHITE CENTER

MEDICARE: CHARLOTTE WHITE CENTER
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
1261QR0405XSubstance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number : 1649337197
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLOTTE WHITE CENTER
Provider Business Mailing Address
First Line : PO BOX 380
Second Line : 572 BANGOR ROAD
City : DOVER FOXCROFT
State : ME
Zip : 04426-0380
Country : US
Telephone Number : 207-564-2464
Fax Number : 204-564-2404
Provider Business Practice Location Address
First Line : 59 RIVER ST
Second Line :
City : DOVER FOXCROFT
State : ME
Zip : 04426-1322
Country : US
Telephone Number : 207-564-2464
Fax Number : 207-564-2404
Authorized Official
Title or Position : CREDENTIALING COORDINATOR
Name : MS. LYNN M LAMB
Credential :
Telephone Number : 207-564-2464
Provider Enumeration Date : 01/03/2007
Last Update Date : 08/22/2020

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Directions to “CHARLOTTE WHITE CENTER ” Practice Location

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