Provider Demographics
NPI:1497991715
Name:SPECIAL CHILDREN'S FRIENDS, INC.
Entity Type:Organization
Organization Name:SPECIAL CHILDREN'S FRIENDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-667-2430
Mailing Address - Street 1:78 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1551
Mailing Address - Country:US
Mailing Address - Phone:207-667-2430
Mailing Address - Fax:207-667-1175
Practice Address - Street 1:78 UNION ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1551
Practice Address - Country:US
Practice Address - Phone:207-667-2430
Practice Address - Fax:207-667-1175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X
ME476365252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109640100Medicaid
ME109640000Medicaid