Provider Demographics
NPI:1225720592
Name:UNITED CEREBRAL PALSY OF NORTHEASTERN MAINE
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF NORTHEASTERN MAINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERUBE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:207-941-2952
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 320
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5680
Mailing Address - Country:US
Mailing Address - Phone:207-941-2952
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE STE 320
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5680
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities