Organization
GRACE STREET SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN JOSEPH OBRIEN SR. LADC (DIRECTOR)
(207) 212-9258
Entity
Organization
Contact information
Practice address
105 MIDDLE ST, LEWISTON, ME 04240-7037
(207) 212-9258
Mailing address
105 MIDDLE ST, LEWISTON, ME 04240-7037
(207) 212-9258
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
605962
ME
251S00000X
Community/Behavioral Health Agency
606205
ME
Other
Enumeration date
08/06/2010
Last updated
08/06/2010
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