Provider Demographics
NPI:1164496410
Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Other - Org Name:RICHMOND AREA HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INSURANCE CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:A
Authorized Official - Last Name:QUIMBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-864-2699
Mailing Address - Street 1:24 GARDINER ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:ME
Mailing Address - Zip Code:04357-1336
Mailing Address - Country:US
Mailing Address - Phone:207-737-4359
Mailing Address - Fax:207-737-4412
Practice Address - Street 1:24 GARDINER ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:ME
Practice Address - Zip Code:04357-1336
Practice Address - Country:US
Practice Address - Phone:207-737-4359
Practice Address - Fax:207-737-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEE58728261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME137970105Medicaid
MECA2004OtherRAILROAD MEDICARE GROUP
ME201806Medicare Oscar/Certification
MECA2004OtherRAILROAD MEDICARE GROUP
MM4659Medicare ID - Type Unspecified