Provider Demographics
NPI:1477604221
Name:INDEPENDENCE ASSOCIATION, INC
Entity Type:Organization
Organization Name:INDEPENDENCE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-725-4371
Mailing Address - Street 1:87 BARIBEAU DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-3229
Mailing Address - Country:US
Mailing Address - Phone:207-725-4371
Mailing Address - Fax:207-725-1416
Practice Address - Street 1:87 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3229
Practice Address - Country:US
Practice Address - Phone:207-725-4371
Practice Address - Fax:207-725-1416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME278241251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health