Individual
MRS. MARY LYNN DOUYARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
378 PEQUAWKET LAKE RD., LIMINGTON, ME 04049
(207) 637-3546
Mailing address
PO BOX 108, EAST BALDWIN, ME 04024-0108
(207) 637-3546
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
01
—
212930000
MAINE CARE PROVIDER NUMBER
ME
Enumeration date
10/07/2010
Last updated
10/07/2010
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