Organization
THE MAINE FITNESS STORE, INC
Active
Other names
Maine Fitness
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY N LEACH (PRESIDENT)
(207) 990-4552
Entity
Organization
Contact information
Practice address
849 STILLWATER AVE, SUITE 1, BANGOR, ME 04401-3624
(207) 990-4552
(207) 990-4552
Mailing address
849 STILLWATER AVE, SUITE 1, BANGOR, ME 04401-3624
(207) 990-4552
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03103032
MEMIC
ME
Enumeration date
10/18/2008
Last updated
10/18/2008
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