Provider Demographics
NPI:1467509885
Name:CHARTRAND, PAUL
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CHARTRAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:ME
Mailing Address - Zip Code:04606-0017
Mailing Address - Country:US
Mailing Address - Phone:207-483-6604
Mailing Address - Fax:
Practice Address - Street 1:369 WESTSIDE ROAD
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:ME
Practice Address - Zip Code:04606-0017
Practice Address - Country:US
Practice Address - Phone:207-483-6604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 1379320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME215480001Medicaid
ME144760000Medicaid