Organization
BERNADETTE FORTIN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNADETTE M FORTIN (OWNER)
(207) 868-9853
Entity
Organization
Contact information
Practice address
144 HIGH ST, VAN BUREN, ME 04785
(207) 868-9853
Mailing address
144 HIGH ST, VAN BUREN, ME 04785
(207) 868-9853
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
217680000
—
ME
Enumeration date
06/30/2009
Last updated
06/30/2009
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