Provider Demographics
NPI:1154497030
Name:CHARLOTTE WHITE CENTER
Entity Type:Organization
Organization Name:CHARLOTTE WHITE CENTER
Other - Org Name:STARKS HOUSE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-564-2464
Mailing Address - Street 1:572 BANGOR RD
Mailing Address - Street 2:
Mailing Address - City:DOVER FOXCROFT
Mailing Address - State:ME
Mailing Address - Zip Code:04426-3373
Mailing Address - Country:US
Mailing Address - Phone:207-564-2464
Mailing Address - Fax:207-564-2404
Practice Address - Street 1:9 PAUL ST
Practice Address - Street 2:
Practice Address - City:DOVER FOXCROFT
Practice Address - State:ME
Practice Address - Zip Code:04426-1050
Practice Address - Country:US
Practice Address - Phone:207-564-2464
Practice Address - Fax:207-564-2404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME164850001Medicaid