Organization
DAWN OUELLETTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAWN M OUELLETTE (HOME PROVIDER)
(207) 444-4562
Entity
Organization
Contact information
Practice address
13 SOUTH BROOK LANE, EAGLE LAKE, ME 04739
(207) 444-4562
(207) 444-4069
Mailing address
13 SOUTH BROOK LANE, EAGLE LAKE, ME 04739
(207) 444-4562
(207) 444-4069
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
—
202220000
—
ME
Enumeration date
04/15/2009
Last updated
04/15/2009
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