| NPI | 1558647461 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEN JOHNSON Vice President 1603-296-0953 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: ME MC12138) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2011-10-25 |