Provider Demographics
NPI:1578699120
Name:TOWN OF CHERRYFIELD
Entity Type:Organization
Organization Name:TOWN OF CHERRYFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:MONA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-546-2376
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:CHERRYFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04622
Mailing Address - Country:US
Mailing Address - Phone:207-546-2376
Mailing Address - Fax:207-546-0927
Practice Address - Street 1:5 ROBBINS GARDENS LANE
Practice Address - Street 2:
Practice Address - City:CHERRYFIELD
Practice Address - State:ME
Practice Address - Zip Code:04622
Practice Address - Country:US
Practice Address - Phone:207-546-2226
Practice Address - Fax:207-546-0927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME157341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME007777OtherANTHEM
ME136340000Medicaid
ME708615Medicare ID - Type Unspecified