| NPI | 1770722902 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERRY BRUCE KEENE Administrator 207-774-2552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: ME ALLS3219) |
| Additional Taxonomies | 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: ME ALLS3219) |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-02-11 |