Organization
OCEAN WAY MENTAL HEALTH AGENCY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURIE TARDIFF (OWNER)
(207) 354-8184
Entity
Organization
Contact information
Practice address
78 BEECHWOOD ST, THOMASTON, ME 04861-3621
(207) 354-8184
(207) 354-8184
Mailing address
78 BEECHWOOD ST, THOMASTON, ME 04861-3621
(207) 354-8184
(207) 354-8184
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
590803
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
435055100
MAINE CARE ID NUMBER
ME
Enumeration date
09/10/2010
Last updated
09/10/2010
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