Provider Demographics
NPI:1467489666
Name:EAST GRAND HEALTH CENTER, INC
Entity Type:Organization
Organization Name:EAST GRAND HEALTH CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHTS
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:207-448-2347
Mailing Address - Street 1:201 HOULTON RD
Mailing Address - Street 2:
Mailing Address - City:DANFORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04424
Mailing Address - Country:US
Mailing Address - Phone:207-448-2347
Mailing Address - Fax:207-448-2313
Practice Address - Street 1:201 HOULTON RD
Practice Address - Street 2:
Practice Address - City:DANFORTH
Practice Address - State:ME
Practice Address - Zip Code:04424
Practice Address - Country:US
Practice Address - Phone:207-448-2347
Practice Address - Fax:207-448-2313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104590000Medicaid
ME201830Medicare Oscar/Certification