Provider Demographics
NPI:1467573469
Name:ST. CROIX REGIONAL FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:ST. CROIX REGIONAL FAMILY HEALTH CENTER
Other - Org Name:ST. CROIX REGIONAL AT CALAIS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CORINNE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAPLANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-796-5503
Mailing Address - Street 1:136 MILL ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:ME
Mailing Address - Zip Code:04668-3344
Mailing Address - Country:US
Mailing Address - Phone:207-796-5503
Mailing Address - Fax:207-796-5528
Practice Address - Street 1:5 LOWELL ST STE 4
Practice Address - Street 2:
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619-1712
Practice Address - Country:US
Practice Address - Phone:207-796-5503
Practice Address - Fax:207-796-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201861Medicare Oscar/Certification