Provider Demographics
NPI:1538399530
Name:THE IRIS NETWORK
Entity type:Organization
Organization Name:THE IRIS NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF FINANCE & ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRABOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-774-6273
Mailing Address - Street 1:189 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2909
Mailing Address - Country:US
Mailing Address - Phone:207-774-6273
Mailing Address - Fax:207-774-0679
Practice Address - Street 1:189 PARK AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2909
Practice Address - Country:US
Practice Address - Phone:207-774-6273
Practice Address - Fax:207-774-0679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-24
Last Update Date:2009-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME101600001Medicaid
ME0806Medicare PIN