Provider Demographics
NPI:1558501866
Name:SHERYL A. PARENT
Entity Type:Organization
Organization Name:SHERYL A. PARENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PARENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-868-2674
Mailing Address - Street 1:344 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1327
Mailing Address - Country:US
Mailing Address - Phone:207-868-2674
Mailing Address - Fax:207-868-3371
Practice Address - Street 1:344 MAIN ST
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785-1327
Practice Address - Country:US
Practice Address - Phone:207-868-2674
Practice Address - Fax:207-868-3371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME218080000Medicaid