Provider Demographics
NPI:1467923540
Name:ST. GEORGES CHILDCARE CENTER
Entity Type:Organization
Organization Name:ST. GEORGES CHILDCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIOR ANALYST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, BCBA
Authorized Official - Phone:617-448-1053
Mailing Address - Street 1:407 YORK STREET
Mailing Address - Street 2:
Mailing Address - City:YORK HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:03909
Mailing Address - Country:US
Mailing Address - Phone:207-606-0738
Mailing Address - Fax:
Practice Address - Street 1:407 YORK STREET
Practice Address - Street 2:
Practice Address - City:YORK HARBOR
Practice Address - State:ME
Practice Address - Zip Code:03909
Practice Address - Country:US
Practice Address - Phone:207-606-0738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities