Provider Demographics
NPI:1497729750
Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Other - Org Name:RANGELEY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-861-3407
Mailing Address - Street 1:PO BOX 569
Mailing Address - Street 2:42 DALLAS HILL ROAD
Mailing Address - City:RANGELEY
Mailing Address - State:ME
Mailing Address - Zip Code:04970
Mailing Address - Country:US
Mailing Address - Phone:207-864-3947
Mailing Address - Fax:207-864-2969
Practice Address - Street 1:42 DALLAS HILL RD
Practice Address - Street 2:
Practice Address - City:RANGELEY
Practice Address - State:ME
Practice Address - Zip Code:04970
Practice Address - Country:US
Practice Address - Phone:207-864-3303
Practice Address - Fax:207-864-2969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEE58728261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME137970110Medicaid
MM5588Medicare ID - Type Unspecified
MECA2004Medicare PIN
ME137970110Medicaid