Organization
PREBLE STREET
Active
Parent organization
PREBLE STREET
Other names
Teen Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
PREBLE STREET
Authorized official
MARK SWANN (EXECUTIVE DIRECTOR)
(207) 775-0026
Entity
Organization
Contact information
Practice address
343 CUMBERLAND STREET, PORTLAND, ME 04101
(207) 775-0026
(207) 842-3614
Mailing address
55 PORTLAND ST, PORTLAND, ME 04101-2921
(207) 775-0026
(207) 842-3614
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431576202
—
ME
Enumeration date
09/23/2008
Last updated
01/28/2025
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