Organization
STATE OF MAINE
Active
Other names
OACPDS
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GAGNON (FINANCIAL MANAGER)
(207) 624-4675
Entity
Organization
Contact information
Practice address
32 BLOSSOM LN, AUGUSTA, ME 04333-0001
(207) 287-4242
(207) 287-9915
Mailing address
109 CAPITOL STREET SHS#11 REIMBURSEMENT UNIT, AUGUSTA, ME 04333-0011
(207) 287-7418
(207) 287-1862
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
NONE
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135910304
—
ME
05
—
135910311
—
ME
05
—
135910312
—
ME
05
—
135910313
—
ME
05
—
135910314
—
ME
05
—
135910315
—
ME
Enumeration date
04/10/2009
Last updated
06/14/2019
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