Provider Demographics
NPI:1437392495
Name:PICC'S PLUS
Entity Type:Organization
Organization Name:PICC'S PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KESLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MSN
Authorized Official - Phone:207-208-9179
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0415
Mailing Address - Country:US
Mailing Address - Phone:207-208-9179
Mailing Address - Fax:
Practice Address - Street 1:25 MAQUOIT RD
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-208-9179
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MER053554251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care