Provider Demographics
NPI:1124834973
Name:GEORGE STEVENS ACADEMY SBWC
Entity type:Organization
Organization Name:GEORGE STEVENS ACADEMY SBWC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VOLUNTEER-STUDENT HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CRNP
Authorized Official - Phone:207-610-0127
Mailing Address - Street 1:23 UNION ST
Mailing Address - Street 2:
Mailing Address - City:BLUE HILL
Mailing Address - State:ME
Mailing Address - Zip Code:04614-5908
Mailing Address - Country:US
Mailing Address - Phone:207-374-2808
Mailing Address - Fax:
Practice Address - Street 1:23 UNION ST
Practice Address - Street 2:
Practice Address - City:BLUE HILL
Practice Address - State:ME
Practice Address - Zip Code:04614-5908
Practice Address - Country:US
Practice Address - Phone:207-374-2808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGE STEVENS ACADEMY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health