Provider Demographics
NPI:1225341316
Name:PAINTED HORSES LLC
Entity Type:Organization
Organization Name:PAINTED HORSES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-837-7671
Mailing Address - Street 1:95 MCLAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:ME
Mailing Address - Zip Code:04949-3715
Mailing Address - Country:US
Mailing Address - Phone:207-837-7671
Mailing Address - Fax:207-737-7137
Practice Address - Street 1:95 MCLAIN ROAD
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:ME
Practice Address - Zip Code:04949-3715
Practice Address - Country:US
Practice Address - Phone:207-837-7671
Practice Address - Fax:207-737-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC85011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME333090099Medicaid
MEME0962OtherMEDICARE ID TYPE UNSPECIFIED