Provider Demographics
NPI:1639365349
Name:BROADREACH FAMILY AND COMMUNITY SERVICES
Entity Type:Organization
Organization Name:BROADREACH FAMILY AND COMMUNITY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAIR
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSTREET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-338-2200
Mailing Address - Street 1:5 STEPHENSON LN
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7230
Mailing Address - Country:US
Mailing Address - Phone:207-338-2200
Mailing Address - Fax:207-338-1652
Practice Address - Street 1:5 STEPHENSON LN
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7230
Practice Address - Country:US
Practice Address - Phone:207-338-2200
Practice Address - Fax:207-338-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME403530251300000X
ME251B00000X, 251C00000X, 251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME124270000Medicaid
ME124270100Medicaid
ME124270202Medicaid