Organization
PROVIDENCE SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE ZENGA (DIRECTOR OF OPERATIONS)
(207) 373-0620
Entity
Organization
Contact information
Practice address
469 MAIN ST, SPRINGVALE, ME 04083-1870
(207) 490-6600
Mailing address
PO BOX 758866, BALTIMORE, MD 21275-8866
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
392123
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19170000
—
ME
Enumeration date
12/06/2012
Last updated
12/06/2012
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