Provider Demographics
NPI:1043442320
Name:WASHINGTON COUNTY CHILDREN'S PROGRAM BRD.
Entity Type:Organization
Organization Name:WASHINGTON COUNTY CHILDREN'S PROGRAM BRD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-255-3426
Mailing Address - Street 1:PO BOX 311
Mailing Address - Street 2:
Mailing Address - City:MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04654-0311
Mailing Address - Country:US
Mailing Address - Phone:207-255-3426
Mailing Address - Fax:207-255-3426
Practice Address - Street 1:14 STEVES LANE
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-3426
Practice Address - Fax:207-255-3426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2212251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109210100Medicaid