Provider Demographics
NPI:1477787125
Name:LAUREL ROUILLARD
Entity Type:Organization
Organization Name:LAUREL ROUILLARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-582-7997
Mailing Address - Street 1:213 HUNTS MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:PITTSTON
Mailing Address - State:ME
Mailing Address - Zip Code:04345-5942
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:213 HUNTS MEADOW RD
Practice Address - Street 2:
Practice Address - City:PITTSTON
Practice Address - State:ME
Practice Address - Zip Code:04345-5942
Practice Address - Country:US
Practice Address - Phone:207-582-7997
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME205660000320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME205660000OtherMAINE CARE