Provider Demographics
NPI:1518034453
Name:PENQUIS C.A.P., INC.
Entity Type:Organization
Organization Name:PENQUIS C.A.P., INC.
Other - Org Name:W110 DAY PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-973-3500
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1162
Mailing Address - Country:US
Mailing Address - Phone:207-973-3500
Mailing Address - Fax:
Practice Address - Street 1:262 HARLOW ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4952
Practice Address - Country:US
Practice Address - Phone:207-973-3500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME164840602Medicaid