# PORTLAND OPIOID HEALTH HOME

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1841855301
- **Authorized official:** CONSTANCE W JORDAN NP (CEO)
- **Authorized official phone:** (207) 808-1384

## Contact information

- **Practice address:** 48 FREE ST., MEZZANINE LEVEL, PORTLAND, ME 04101
- **Practice address phone:** (207) 808-1384
- **Practice address fax:** (207) 221-1710
- **Mailing address:** 48 FREE ST., MEZZANINE LEVEL, PORTLAND, ME 04101
- **Mailing address phone:** (207) 808-1384
- **Mailing address fax:** (207) 221-1710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 101YA0400X | Addiction (Substance Use Disorder) Counselor | — | — | Yes |

## Other

- **Enumeration date:** 05/09/2019
- **Last updated:** 05/09/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 193200000X | — | ME |