Provider Demographics
NPI:1659522647
Name:TEDFORD HOUSING- COMMUNITY HOMELESS PREVENTION
Entity Type:Organization
Organization Name:TEDFORD HOUSING- COMMUNITY HOMELESS PREVENTION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DON
Authorized Official - Middle Name:
Authorized Official - Last Name:KNISELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:2077-291-1961
Mailing Address - Street 1:P.O. BOX 958
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-729-1161
Mailing Address - Fax:207-725-7626
Practice Address - Street 1:34 FEDERAL STREET
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-729-6618
Practice Address - Fax:207-725-7625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME117540001Medicaid