Organization
ST. JOHN VALLEY FOSTER HOME
Active
Other names
Sharon L. Gagnon
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON L GAGNON (FOSTER HOME OPERATOR)
(207) 868-2243
Entity
Organization
Contact information
Practice address
122 CHURCH STREET, VAN BUREN, ME 04785-1446
(207) 868-2243
Mailing address
122 CHURCH STREET, VAN BUREN, ME 04785-1446
(207) 868-2243
(207) 868-2243
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
—
200130000
—
ME
Enumeration date
03/20/2009
Last updated
03/20/2009
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