Organization
WATCH ME SHINE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TIFFANY S. PETRONIS (EXECUTIVE DIRECTOR)
(207) 664-8132
Entity
Organization
Contact information
Practice address
28 GILMAN PLAZA, BANGOR, ME 04401
(207) 990-0162
(207) 990-0163
Mailing address
122 JILLIAN WAY, C/O TIFFANY PETRONIS, GLENBURN, ME 04401
(207) 990-0162
(207) 990-0163
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
609327
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4323532200
MAINECARE FSD
ME
01
—
432418200
MAINECARE
ME
Enumeration date
06/19/2009
Last updated
02/13/2015
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