Provider Demographics
NPI:1639245053
Name:POTTLE HILL, INC.
Entity Type:Organization
Organization Name:POTTLE HILL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-753-1457
Mailing Address - Street 1:PO BOX 1537
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04211-1537
Mailing Address - Country:US
Mailing Address - Phone:207-753-1457
Mailing Address - Fax:207-753-0505
Practice Address - Street 1:368 MINOT AVE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-4331
Practice Address - Country:US
Practice Address - Phone:207-753-1457
Practice Address - Fax:207-753-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111020100Medicaid
ME111020101Medicaid
ME111020001Medicaid
ME111020002Medicaid
ME111020103Medicaid
ME111020000Medicaid