| NPI | 1124101464 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JULIE WELCH Office Manager 207-778-0035 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X (Licence: ME 227282) |
| Additional Taxonomies | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder (Licence: ME 221361) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2016-05-03 |