Provider Demographics
NPI:1518191691
Name:THE EMMA R FOUNDATION LLC
Entity Type:Organization
Organization Name:THE EMMA R FOUNDATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:AVA
Authorized Official - Last Name:HEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-562-8098
Mailing Address - Street 1:577 COMMON RD
Mailing Address - Street 2:
Mailing Address - City:DIXFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04224-4427
Mailing Address - Country:US
Mailing Address - Phone:207-562-8098
Mailing Address - Fax:
Practice Address - Street 1:577 COMMON RD
Practice Address - Street 2:
Practice Address - City:DIXFIELD
Practice Address - State:ME
Practice Address - Zip Code:04224-4427
Practice Address - Country:US
Practice Address - Phone:207-562-8098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432369500Medicaid
ME432799600Medicaid