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Organization

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Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TAMMY LYNN MARTIN/TRASK ADMINISTRATOR,CRMA, (PROPRIETOR/ADMINISTRATOR)
(207) 943-2000
Entity
Organization

Contact information

Practice address
90 PARK ST, SITE#1, MILO, ME 04463-1738
(207) 943-2000
Mailing address
90 PARK ST PO BX 55, SUITE#1, MILO, ME 04463
(207) 943-6082

Taxonomy

Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
ALLS6551
ME

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
3747P1801X
PERSONNEL CARE AGENCY
ME
Enumeration date
05/13/2015
Last updated
05/13/2015
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