Provider Demographics
NPI:1255492294
Name:MAINE GENERAL COMMUNITY CARE
Entity Type:Organization
Organization Name:MAINE GENERAL COMMUNITY CARE
Other - Org Name:DAYSPRING
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OF REVNUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VICTORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-861-3488
Mailing Address - Street 1:8 HIGHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-5740
Mailing Address - Country:US
Mailing Address - Phone:207-861-3488
Mailing Address - Fax:207-861-3470
Practice Address - Street 1:8 HIGHWOOD ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-5740
Practice Address - Country:US
Practice Address - Phone:207-861-3488
Practice Address - Fax:207-861-3470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME221903251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132510300Medicaid