Provider Demographics
NPI:1972738193
Name:BRIDGES OF MAINE, LLC
Entity type:Organization
Organization Name:BRIDGES OF MAINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-657-5585
Mailing Address - Street 1:PO BOX 1386
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-1386
Mailing Address - Country:US
Mailing Address - Phone:207-657-5585
Mailing Address - Fax:207-657-5584
Practice Address - Street 1:20 SHAKER ROAD
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039
Practice Address - Country:US
Practice Address - Phone:207-657-5585
Practice Address - Fax:207-657-5584
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431811300Medicaid
ME431934200Medicaid
ME155470000Medicaid