| NPI | 1780888420 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN MICHAEL PARKER District Eap Consultant 207-854-5416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: ME LC 4924) |
| Additional Taxonomies | 305R00000X Preferred Provider Organization (Licence: ME LC4924) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2020-08-22 |