| NPI | 1154440113 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN F PITTS Program Administrator 207-232-0975 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Additional Taxonomies | 311ZA0620X Custodial Care Facility, Adult Care Home |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2009-12-15 |