Provider Demographics
NPI:1578272720
Name:CCM-4U, LLC
Entity Type:Organization
Organization Name:CCM-4U, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOUTILIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-262-9799
Mailing Address - Street 1:PO BOX 752
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-0752
Mailing Address - Country:US
Mailing Address - Phone:207-262-9799
Mailing Address - Fax:207-262-9662
Practice Address - Street 1:611 HAMMOND ST
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4571
Practice Address - Country:US
Practice Address - Phone:207-262-9799
Practice Address - Fax:207-262-9662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-16
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management