Organization
RSU # 21
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN MULSOW (DIRECTOR OF SPECIAL SERVICES)
(207) 985-1100
Entity
Organization
Contact information
Practice address
87 FLETCHER ST, KENNEBUNK, ME 04043-6850
(207) 985-1100
Mailing address
87 FLETCHER ST, KENNEBUNK, ME 04043-6850
(207) 985-1100
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104380001
—
ME
Enumeration date
05/11/2007
Last updated
10/22/2009
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