Provider Demographics
NPI:1184009128
Name:FRANNIE PEABODY CENTER
Entity Type:Organization
Organization Name:FRANNIE PEABODY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:FITZGERALD
Authorized Official - Last Name:JOANETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-774-6877
Mailing Address - Street 1:30 DANFORTH ST STE 311
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4574
Mailing Address - Country:US
Mailing Address - Phone:207-774-6877
Mailing Address - Fax:207-879-0761
Practice Address - Street 1:30 DANFORTH ST STE 311
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4574
Practice Address - Country:US
Practice Address - Phone:207-774-6877
Practice Address - Fax:207-879-0761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME683146251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1992935662Medicaid