Provider Demographics
NPI:1558489930
Name:EMPLOYMENT SPECIALISTS OF MAINE, INC.
Entity Type:Organization
Organization Name:EMPLOYMENT SPECIALISTS OF MAINE, INC.
Other - Org Name:ESM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GALLANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-622-5946
Mailing Address - Street 1:776 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8307
Mailing Address - Country:US
Mailing Address - Phone:207-622-5946
Mailing Address - Fax:207-622-4667
Practice Address - Street 1:776 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8307
Practice Address - Country:US
Practice Address - Phone:207-622-5946
Practice Address - Fax:207-622-4667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME237203251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME123900000Medicaid