Provider Demographics
NPI:1124032347
Name:PINE TREE SOCIETY INC
Entity type:Organization
Organization Name:PINE TREE SOCIETY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:NOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-386-5901
Mailing Address - Street 1:149 FRONT ST.
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:207-443-3341
Mailing Address - Fax:207-443-1070
Practice Address - Street 1:149 FRONT ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2610
Practice Address - Country:US
Practice Address - Phone:207-443-3341
Practice Address - Fax:207-443-1070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7145Medicare ID - Type Unspecified