Organization
PORTLAND OPIOID HEALTH HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CONSTANCE W JORDAN NP (CEO)
(207) 808-1384
Entity
Organization
Contact information
Practice address
48 FREE ST., MEZZANINE LEVEL, PORTLAND, ME 04101
(207) 808-1384
(207) 221-1710
Mailing address
48 FREE ST., MEZZANINE LEVEL, PORTLAND, ME 04101
(207) 808-1384
(207) 221-1710
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
193200000X
—
ME
Enumeration date
05/09/2019
Last updated
05/09/2019
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