Provider Demographics
NPI:1598482226
Name:SACO RIVER ACUPUNCTURE PLLC
Entity Type:Organization
Organization Name:SACO RIVER ACUPUNCTURE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENEVIEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAILLANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:518-929-0367
Mailing Address - Street 1:443 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-2124
Mailing Address - Country:US
Mailing Address - Phone:207-558-1131
Mailing Address - Fax:207-805-2262
Practice Address - Street 1:443 MAIN ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2124
Practice Address - Country:US
Practice Address - Phone:207-558-1131
Practice Address - Fax:207-805-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1245634286OtherNPPES
1861746521OtherNPPES