Provider Demographics
NPI:1558335521
Name:A SPECIAL PLACE, INC.
Entity Type:Organization
Organization Name:A SPECIAL PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-775-4048
Mailing Address - Street 1:1189 CONGRESS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2126
Mailing Address - Country:US
Mailing Address - Phone:207-775-4048
Mailing Address - Fax:207-221-2009
Practice Address - Street 1:1189 CONGRESS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-2126
Practice Address - Country:US
Practice Address - Phone:207-775-4048
Practice Address - Fax:207-221-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0206164332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0149110001Medicare ID - Type Unspecified