Provider Demographics
NPI:1427286384
Name:CARE DEVELOPMENT OF MAINE
Entity type:Organization
Organization Name:CARE DEVELOPMENT OF MAINE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-945-4240
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0936
Mailing Address - Country:US
Mailing Address - Phone:207-945-4240
Mailing Address - Fax:207-299-1102
Practice Address - Street 1:40 SUMMER ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6446
Practice Address - Country:US
Practice Address - Phone:207-945-4240
Practice Address - Fax:207-299-1102
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARE DEVELOPMENT OF MAINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME534881251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME133900201Medicaid