Provider Demographics
NPI:1174641047
Name:TOWN OF KENNEBUNKPORT MAINE
Entity Type:Organization
Organization Name:TOWN OF KENNEBUNKPORT MAINE
Other - Org Name:KENNEBUNKPORT PUBLIC HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:KENNEBUNKPORT PUBLIC HEALTH ADMINIS
Authorized Official - Prefix:MS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RN BS
Authorized Official - Phone:207-967-4401
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:KENNEBUNKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04046
Mailing Address - Country:US
Mailing Address - Phone:207-967-4401
Mailing Address - Fax:207-967-3633
Practice Address - Street 1:101 MAIN STREET
Practice Address - Street 2:POLICE COMMUNICATIONS PUBLIC HEALTH COMPLEX
Practice Address - City:KENNEBUNKPORT
Practice Address - State:ME
Practice Address - Zip Code:04046
Practice Address - Country:US
Practice Address - Phone:207-967-4401
Practice Address - Fax:207-967-3633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER015836163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5067Medicare PIN