| Maps | |
|
100 Brickhill Ave South Portland ME 04106-1999 | |
| (207) 775-4101 | |
| Not Available |
| Full Name | Maps |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 100 Brickhill Ave, South Portland, Maine |
| Authorized Official Name and Position | Peter Rand (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 2077754101 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maps 100 Brickhill Ave South Portland ME 04106-1999 Ph: () - | Maps 100 Brickhill Ave South Portland ME 04106-1999 Ph: (207) 775-4101 |
| NPI Number | 1831474493 |
|---|---|
| Provider Enumeration Date | 10/14/2011 |
| Last Update Date | 10/14/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831474493 | NPI | - | NPPES |
| 1457593287 | Medicaid | ME | |
| 1538484266 | Medicaid | ME | |
| 431730800 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 576160 (Maine) | Primary |
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