Provider Demographics
NPI:1467654830
Name:UNITED CEREBRAL PALSY OF NORTHEASTERN MAINE
Entity Type:Organization
Organization Name:UNITED CEREBRAL PALSY OF NORTHEASTERN MAINE
Other - Org Name:UCP OF MAINE
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-992-0602
Mailing Address - Street 1:700 MT HOPE AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5680
Mailing Address - Country:US
Mailing Address - Phone:207-941-2952
Mailing Address - Fax:207-941-2955
Practice Address - Street 1:700 MT HOPE AVE
Practice Address - Street 2:SUITE 320
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5680
Practice Address - Country:US
Practice Address - Phone:207-941-2952
Practice Address - Fax:207-941-2955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME402831251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME167950200Medicaid