Provider Demographics
NPI:1588738082
Name:CHARLOTTE WHITE CENTER
Entity type:Organization
Organization Name:CHARLOTTE WHITE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-564-2464
Mailing Address - Street 1:572 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-3373
Mailing Address - Country:US
Mailing Address - Phone:207-564-2464
Mailing Address - Fax:207-564-2404
Practice Address - Street 1:572 BANGOR RD
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-3373
Practice Address - Country:US
Practice Address - Phone:207-564-2464
Practice Address - Fax:207-564-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431531300Medicaid