Provider Demographics
NPI:1083028765
Name:PROTEA INTEGRATED HEALTH AND WELLNESS, LLC
Entity Type:Organization
Organization Name:PROTEA INTEGRATED HEALTH AND WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF VOCATIONAL SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:LEIGH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-430-3777
Mailing Address - Street 1:52 WATER ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HALLOWELL
Mailing Address - State:ME
Mailing Address - Zip Code:04347-1437
Mailing Address - Country:US
Mailing Address - Phone:207-430-3777
Mailing Address - Fax:207-621-4020
Practice Address - Street 1:52 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1437
Practice Address - Country:US
Practice Address - Phone:207-430-3777
Practice Address - Fax:207-621-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-20
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME672176251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health