Provider Demographics
NPI:1619183696
Name:PORTLAND WEST INC.
Entity Type:Organization
Organization Name:PORTLAND WEST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF PROGRAMS
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:L
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSSA
Authorized Official - Phone:207-775-0105
Mailing Address - Street 1:181 BRACKETT ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3857
Mailing Address - Country:US
Mailing Address - Phone:207-775-0105
Mailing Address - Fax:207-780-1701
Practice Address - Street 1:181 BRACKETT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3857
Practice Address - Country:US
Practice Address - Phone:207-775-0105
Practice Address - Fax:207-780-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management