Individual
MR. RANDALL S ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
52 GARDNER STREET, APT A, PATTEN, ME 04765
(207) 538-5279
Mailing address
PO BOX 226, PATTEN, ME 04765-0226
(207) 538-5279
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
—
432861500
—
ME
Enumeration date
05/06/2009
Last updated
05/06/2009
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