Organization
MAINE RESOURCE DEVELOPMENT CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JERRY BRUCE KEENE (ADMINISTRATOR)
(207) 774-2552
Entity
Organization
Contact information
Practice address
18 LINCOLN ST, PORTLAND, ME 04103-4408
(207) 774-2552
Mailing address
18 LINCOLN ST, PORTLAND, ME 04103-4408
(207) 774-2552
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
ALLS3219
ME
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
ALLS3219
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109270000
—
ME
Enumeration date
02/11/2009
Last updated
02/11/2009
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