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Organization
SEVENTY FIVE STATE STREET
Active
Organization
SEVENTY FIVE STATE STREET
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ANTHONY FORGIONE (PRESIDENT/CEO)
(207) 772-2675
Entity
Organization
Contact information
Practice address
75 STATE ST, PORTLAND, ME 04101-3746
(207) 772-2675
(207) 772-2896
Mailing address
75 STATE ST, PORTLAND, ME 04101-3746
(207) 772-2675
(207) 772-2896
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
ALLS2085
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101970000
—
ME
Enumeration date
04/17/2009
Last updated
10/01/2009
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