Provider Demographics
NPI:1528213352
Name:ADDICTION RESOURCE CENTER
Entity Type:Organization
Organization Name:ADDICTION RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-373-6971
Mailing Address - Street 1:66 BARIBEAU DRIVE
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-373-6971
Mailing Address - Fax:207-373-6959
Practice Address - Street 1:66 BARIBEAU DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3230
Practice Address - Country:US
Practice Address - Phone:207-373-6971
Practice Address - Fax:207-373-6959
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MID COAST HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102140100Medicaid