Provider Demographics
NPI:1639139140
Name:PENOBSCOT INDIAN NATION FINANCE OFFICE
Entity Type:Organization
Organization Name:PENOBSCOT INDIAN NATION FINANCE OFFICE
Other - Org Name:PENOBSCOT NATION HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-817-7404
Mailing Address - Street 1:23 WABANAKI WAY
Mailing Address - Street 2:
Mailing Address - City:INDIAN ISLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04468-1252
Mailing Address - Country:US
Mailing Address - Phone:207-817-7404
Mailing Address - Fax:207-817-7459
Practice Address - Street 1:23 WABANAKI WAY
Practice Address - Street 2:
Practice Address - City:INDIAN ISLAND
Practice Address - State:ME
Practice Address - Zip Code:04468-1252
Practice Address - Country:US
Practice Address - Phone:207-817-7404
Practice Address - Fax:207-817-7459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PENOBSCOT INDIAN NATION FINANCE OFFICE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME201818261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME106520100Medicaid
ME106520100Medicaid