Provider Demographics
NPI:1154552206
Name:LIBBY -TARDIF, MARGARET CHRISTINE
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:CHRISTINE
Last Name:LIBBY -TARDIF
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:CHRISTINE
Other - Last Name:TARDIF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04087-0454
Mailing Address - Country:US
Mailing Address - Phone:207-205-6723
Mailing Address - Fax:207-298-9808
Practice Address - Street 1:740 MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04087-3011
Practice Address - Country:US
Practice Address - Phone:207-205-6723
Practice Address - Fax:207-298-9808
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-06
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320800000X, 171M00000X, 311ZA0620X
ME253Z00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No253Z00000XAgenciesIn Home Supportive Care
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME229900000Medicaid