Organization
MAPS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PETER RAND (CHIEF FINANCIAL OFFICER)
(207) 775-4101
Entity
Organization
Contact information
Practice address
100 BRICKHILL AVE, SOUTH PORTLAND, ME 04106-1999
(207) 775-4101
Mailing address
100 BRICKHILL AVE, SOUTH PORTLAND, ME 04106-1999
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
576160
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457593287
—
ME
05
—
1538484266
—
ME
05
—
431730800
—
ME
Enumeration date
10/14/2011
Last updated
10/14/2011
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