Organization
PORT RESOURCES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBIN DEFREEST (DIRECTOR OF FINANCE)
(207) 828-0048
Entity
Organization
Contact information
Practice address
280B GANNETT DR, SOUTH PORTLAND, ME 04106-6940
(207) 828-0048
(207) 772-3743
Mailing address
280B GANNETT DR, SOUTH PORTLAND, ME 04106-6940
(207) 828-0048
(207) 772-3743
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
388111
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110580000
—
ME
Enumeration date
01/26/2007
Last updated
07/16/2014
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