Provider Demographics
NPI:1063816189
Name:RANGELEY REGION HEALTH AND WELLNESS PARTNERSHIP
Entity Type:Organization
Organization Name:RANGELEY REGION HEALTH AND WELLNESS PARTNERSHIP
Other - Org Name:ASCENT - RANGELEY LAKES REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:THORVALDSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-864-4397
Mailing Address - Street 1:PO BOX 722
Mailing Address - Street 2:25 DALLAS HILL RD
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970-0722
Mailing Address - Country:US
Mailing Address - Phone:207-864-4397
Mailing Address - Fax:207-864-9062
Practice Address - Street 1:25 DALLAS HILL ROAD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970-0722
Practice Address - Country:US
Practice Address - Phone:207-864-4397
Practice Address - Fax:207-864-9062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-17
Last Update Date:2017-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7584990001Medicare NSC