Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Other names
Adult Wellness Center
Organization subpart
No
Provider details
NPI number
Authorized official
LORELLE DWYER (CEO)
(207) 992-9200
Entity
Organization
Contact information
Practice address
1068 UNION ST, BANGOR, ME 04401-3016
(207) 404-8200
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 404-8200
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
11/08/2019
Last updated
11/08/2019
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