Provider Demographics
NPI:1346363009
Name:INDIAN TOWNSHIP TRIBAL GOVERNMENT
Entity Type:Organization
Organization Name:INDIAN TOWNSHIP TRIBAL GOVERNMENT
Other - Org Name:PASSAMAQUODDY FIRE & RESCUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COMPLIANCE SPECIALISIT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-796-2321
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:ME
Mailing Address - Zip Code:04668-0097
Mailing Address - Country:US
Mailing Address - Phone:207-796-2744
Mailing Address - Fax:207-942-8213
Practice Address - Street 1:443 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668
Practice Address - Country:US
Practice Address - Phone:207-796-2744
Practice Address - Fax:207-942-8213
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PASSAMAQUODDY FIRE & RESCUE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3653416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107940400Medicaid