Provider Demographics
NPI:1386885424
Name:SERVANTS OF THE CROSS
Entity type:Organization
Organization Name:SERVANTS OF THE CROSS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAND
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOUDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-725-7577
Mailing Address - Street 1:32 SKY HY DR
Mailing Address - Street 2:
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-5772
Mailing Address - Country:US
Mailing Address - Phone:207-725-7577
Mailing Address - Fax:207-725-2698
Practice Address - Street 1:32 SKY HY DR
Practice Address - Street 2:
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086-5772
Practice Address - Country:US
Practice Address - Phone:207-725-7577
Practice Address - Fax:207-725-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS2359261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME108930000Medicaid