Provider Demographics
NPI:1972594232
Name:HOSPICE OF SOUTHERN MAINE
Entity type:Organization
Organization Name:HOSPICE OF SOUTHERN MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:QUALITY & COMPLIANCE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-289-3640
Mailing Address - Street 1:390 US ROUTE 1
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9772
Mailing Address - Country:US
Mailing Address - Phone:207-289-3640
Mailing Address - Fax:207-883-1040
Practice Address - Street 1:390 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9772
Practice Address - Country:US
Practice Address - Phone:207-289-3640
Practice Address - Fax:207-883-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-04
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME36152251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201511Medicare ID - Type Unspecified