Provider Demographics
NPI:1699826362
Name:GETCHELL FOSTER HOME
Entity type:Organization
Organization Name:GETCHELL FOSTER HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOSTER PARENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:GETCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-843-7422
Mailing Address - Street 1:219 BRUCKOFF RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:ME
Mailing Address - Zip Code:04428-6038
Mailing Address - Country:US
Mailing Address - Phone:207-843-7422
Mailing Address - Fax:
Practice Address - Street 1:219 BRUCKOFF RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:ME
Practice Address - Zip Code:04428-6038
Practice Address - Country:US
Practice Address - Phone:207-843-7422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS1845320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME216350000OtherMAINE CARE