Individual
MELISSA ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DSP
Contact information
Practice address
46 NEAL ST, GARDINER, ME 04345
(207) 557-4686
Mailing address
46 NEAL ST, GARDINER, ME 04345-2005
(207) 557-4686
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
04/24/2018
Last updated
07/23/2018
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