Provider Demographics
NPI:1063741213
Name:STATE OF MAINE
Entity type:Organization
Organization Name:STATE OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY COMMISSIONER OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:BEGIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-287-5758
Mailing Address - Street 1:221 STATE ST
Mailing Address - Street 2:SHS #11
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6846
Mailing Address - Country:US
Mailing Address - Phone:207-287-7418
Mailing Address - Fax:207-287-1862
Practice Address - Street 1:32 BLOSSOM LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04333-0011
Practice Address - Country:US
Practice Address - Phone:207-287-9200
Practice Address - Fax:207-287-9229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MENONE251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135910302Medicaid