Provider Demographics
NPI:1508198037
Name:ST ANDRE HOME INC.
Entity type:Organization
Organization Name:ST ANDRE HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-282-3351
Mailing Address - Street 1:168 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-3093
Mailing Address - Country:US
Mailing Address - Phone:207-282-3351
Mailing Address - Fax:207-282-8733
Practice Address - Street 1:168 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-3093
Practice Address - Country:US
Practice Address - Phone:207-282-3351
Practice Address - Fax:207-282-8733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME168230000Medicaid
ME435407000Medicaid