Organization
STATE OF MAINE
Active
Other names
Act Team
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GAGNON (FINANCIAL MANAGER)
(207) 624-4675
Entity
Organization
Contact information
Practice address
5 CALDWELL RD, AUGUSTA, ME 04330-0011
(207) 287-5747
(207) 287-5755
Mailing address
109 CAPITOL STREET SHS#11 REIMBURSEMENT UNIT, AUGUSTA, ME 04333-0011
(207) 287-7418
(207) 287-5755
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
526359
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135911607
—
ME
Enumeration date
04/10/2009
Last updated
06/14/2019
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