Organization
CSD #8
Active
Organization subpart
No
Provider details
NPI number
Authorized official
REBECCA ENMAN (BUSINESS MANAGER)
(207) 825-3364
Entity
Organization
Contact information
Practice address
26 GREAT POND RD, AURORA, ME 04408-7032
(207) 825-3364
Mailing address
202 KIDDER HILL RD, HOLDEN, ME 04429-6222
(207) 843-0702
(207) 843-0702
Taxonomy
Speciality
Code
Description
License number
State
251300000X
Local Education Agency (LEA)
Primary
—
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104640000
—
ME
Enumeration date
12/02/2009
Last updated
05/06/2019
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