Organization
THE IRIS NETWORK
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN TRABOLD (DIR OF FINANCE & ADMIN)
(207) 774-6273
Entity
Organization
Contact information
Practice address
189 PARK AVE, PORTLAND, ME 04102-2909
(207) 774-6273
(207) 774-0679
Mailing address
189 PARK AVE, PORTLAND, ME 04102-2909
(207) 774-6273
(207) 774-0679
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101600001
—
ME
Enumeration date
07/24/2009
Last updated
07/24/2009
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