Provider Demographics
NPI:1316187735
Name:DANFORTH HABILITATION ASSOCIATION
Entity Type:Organization
Organization Name:DANFORTH HABILITATION ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MLA
Authorized Official - Phone:207-448-2327
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:7 MAPLE STREET
Mailing Address - City:DANFORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04424-0217
Mailing Address - Country:US
Mailing Address - Phone:207-448-2327
Mailing Address - Fax:207-448-2010
Practice Address - Street 1:7 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:DANFORTH
Practice Address - State:ME
Practice Address - Zip Code:04424-0217
Practice Address - Country:US
Practice Address - Phone:207-448-2327
Practice Address - Fax:207-448-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 3422310400000X
MEALLS 3421310400000X
ME36934313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME115410204Medicaid
ME115410000Medicaid
ME115410200Medicaid
ME115410203Medicaid
ME115410100Medicaid
ME115410201Medicaid