Provider Demographics
NPI:1285762328
Name:CITY OF CALAIS
Entity type:Organization
Organization Name:CITY OF CALAIS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH CENTER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SKRILETZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:207-454-8262
Mailing Address - Street 1:32 BLUE DEVIL HLL
Mailing Address - Street 2:
Mailing Address - City:CALAIS
Mailing Address - State:ME
Mailing Address - Zip Code:04619
Mailing Address - Country:US
Mailing Address - Phone:207-454-8262
Mailing Address - Fax:207-454-8262
Practice Address - Street 1:34 BLUE DEVIL HILL
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619
Practice Address - Country:US
Practice Address - Phone:207-454-8262
Practice Address - Fax:207-454-8262
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF CALAIS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME135990100Medicaid
ME302910099Medicaid