Provider Demographics
NPI:1215171848
Name:MAINE PARENT FEDERATION, INC.
Entity type:Organization
Organization Name:MAINE PARENT FEDERATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:LACHANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-623-2144
Mailing Address - Street 1:PO BOX 2067
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04338-2067
Mailing Address - Country:US
Mailing Address - Phone:207-623-2144
Mailing Address - Fax:207-623-2148
Practice Address - Street 1:12 SHUMAN AVE.
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-623-2144
Practice Address - Fax:207-623-2148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME432263500251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432263500Medicaid