Provider Demographics
NPI:1033398680
Name:THE JASON PROGRAM
Entity Type:Organization
Organization Name:THE JASON PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:H
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-773-2947
Mailing Address - Street 1:65 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2617
Mailing Address - Country:US
Mailing Address - Phone:207-773-2947
Mailing Address - Fax:207-773-3617
Practice Address - Street 1:65 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2617
Practice Address - Country:US
Practice Address - Phone:207-773-2947
Practice Address - Fax:207-773-3617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME012046174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty