Provider Demographics
NPI:1679775456
Name:RESIDENTIAL RESOURCES OF MAINE
Entity Type:Organization
Organization Name:RESIDENTIAL RESOURCES OF MAINE
Other - Org Name:RESIDENTIAL RESOURCES OF MAINE, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTONCINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-287-2911
Mailing Address - Street 1:39 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-3318
Mailing Address - Country:US
Mailing Address - Phone:800-287-2911
Mailing Address - Fax:844-281-0423
Practice Address - Street 1:39 SUMMER ST
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:800-287-2911
Practice Address - Fax:844-281-0423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 251S00000X
ME320800000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02117031Medicaid
NY02497501Medicaid
ME12847000Medicaid
NY01987044Medicaid
NY02111140Medicaid
NY02701288Medicaid