Individual
RONALD PHILLIP SMALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
316 MAIN ST, CORINTH, ME 04427-3031
(207) 285-3281
Mailing address
PO BOX 129, CORINTH, ME 04427-0129
(207) 285-3281
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
ALLS3410
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200550000
—
ME
Enumeration date
09/08/2009
Last updated
09/08/2009
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