| East Grand Health Center, Inc | |
|
201 Houlton Rd Danforth ME 04424 | |
| (207) 448-2347 | |
| (207) 448-2313 |
| Full Name | East Grand Health Center, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 201 Houlton Rd, Danforth, Maine |
| Authorized Official Name and Position | Priscilla Knights (ADMINISTRATOR) |
| Authorized Official Contact | 2074482347 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| East Grand Health Center, Inc 201 Houlton Rd Danforth ME 04424 Ph: (207) 448-2347 | East Grand Health Center, Inc 201 Houlton Rd Danforth ME 04424 Ph: (207) 448-2347 |
| NPI Number | 1467489666 |
|---|---|
| Provider Enumeration Date | 06/26/2006 |
| Last Update Date | 01/06/2009 |
| Medicare PECOS PAC ID | 4284642950 |
|---|---|
| Medicare Enrollment ID | O20060323000065 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467489666 | NPI | - | NPPES |
| 104590000 | Medicaid | ME |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| Provider Name | Dawn C Mcginnis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700858354 PECOS PAC ID: 2567374739 Enrollment ID: I20031105000297 |
| Provider Name | Mark D Kaplan |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1861498461 PECOS PAC ID: 3173580503 Enrollment ID: I20041216000668 |
| Provider Name | Mary A Lake |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578671871 PECOS PAC ID: 1850305467 Enrollment ID: I20060203000091 |
| Provider Name | Rebekah A Ouellette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972736395 PECOS PAC ID: 7810139151 Enrollment ID: I20130815000406 |
| Provider Name | Jared Y Kohlbacher |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1386925055 PECOS PAC ID: 8628201126 Enrollment ID: I20140508000666 |
| Provider Name | Lyndsay R Mciver |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205447067 PECOS PAC ID: 6507286135 Enrollment ID: I20201020000827 |
| Provider Name | Dayna E Lincoln |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033754643 PECOS PAC ID: 9931598679 Enrollment ID: I20211117003292 |