Provider Demographics
NPI:1689811465
Name:MOMENTUM INC
Entity Type:Organization
Organization Name:MOMENTUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:T
Authorized Official - Last Name:STROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-627-2267
Mailing Address - Street 1:1059 MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:CASCO
Mailing Address - State:ME
Mailing Address - Zip Code:04015-3038
Mailing Address - Country:US
Mailing Address - Phone:207-627-2267
Mailing Address - Fax:207-627-2269
Practice Address - Street 1:1059 MEADOW RD
Practice Address - Street 2:
Practice Address - City:CASCO
Practice Address - State:ME
Practice Address - Zip Code:04015-3038
Practice Address - Country:US
Practice Address - Phone:207-627-2267
Practice Address - Fax:207-627-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME134740100OtherMAINECARE BILLING PROVIDER IDENTIFICATION NUMBER