Organization
SUPPORTIVE PARTNERSHIPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE WHEELER (OWNER)
(207) 459-4664
Entity
Organization
Contact information
Practice address
1 FELLOWS ST, PORTLAND, ME 04103-2414
(207) 459-4664
Mailing address
1 FELLOWS ST, PORTLAND, ME 04103-2414
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
11/26/2019
Last updated
11/26/2019
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