Provider Demographics
NPI:1104060045
Name:ST . ANDRE'S HOME, INC.
Entity type:Organization
Organization Name:ST . ANDRE'S HOME, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-282-3351
Mailing Address - Street 1:283 ELM ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3027
Mailing Address - Country:US
Mailing Address - Phone:207-282-3351
Mailing Address - Fax:207-282-8733
Practice Address - Street 1:283 ELM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3027
Practice Address - Country:US
Practice Address - Phone:207-282-3351
Practice Address - Fax:207-282-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME218677251B00000X
ME214603,429481,216796320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME168230100OtherOUTREACH COMMUNITY SERVICES
ME16823000Medicaid