Organization
PENOBSCOT COMMUNITY HEALTH CENTER
Active
Parent organization
PENOBSCOT COMMUNITY HEALTH CENTER
Other names
Bridge Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENOBSCOT COMMUNITY HEALTH CENTER
Authorized official
LORELLE DWYER (PRESIDENT & CEO)
(207) 992-9200
Entity
Organization
Contact information
Practice address
992 UNION ST STE 3, BANGOR, ME 04401-3057
(207) 404-8330
(207) 947-0435
Mailing address
PO BOX 1599, BANGOR, ME 04402-1599
(207) 404-8200
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
131160200
—
ME
Enumeration date
06/12/2007
Last updated
11/13/2020
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