Provider Demographics
NPI:1679711493
Name:BRADLEY D. LANPHERE
Entity Type:Organization
Organization Name:BRADLEY D. LANPHERE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LANPHERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-596-7495
Mailing Address - Street 1:PO BOX 404
Mailing Address - Street 2:
Mailing Address - City:ROCKPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04856-0404
Mailing Address - Country:US
Mailing Address - Phone:207-596-7495
Mailing Address - Fax:207-596-7495
Practice Address - Street 1:30 KIMBERLY DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-0404
Practice Address - Country:US
Practice Address - Phone:207-596-7495
Practice Address - Fax:207-596-7495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities