Provider Demographics
NPI:1700025954
Name:NORTHERN MAINE GENERAL
Entity Type:Organization
Organization Name:NORTHERN MAINE GENERAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:REYNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-444-5152
Mailing Address - Street 1:36 CARTER STREET
Mailing Address - Street 2:
Mailing Address - City:EAGLE LAKE
Mailing Address - State:ME
Mailing Address - Zip Code:04739
Mailing Address - Country:US
Mailing Address - Phone:207-444-5152
Mailing Address - Fax:207-444-6099
Practice Address - Street 1:3388 AROOSTOOK ROAD
Practice Address - Street 2:
Practice Address - City:EAGLE LAKE
Practice Address - State:ME
Practice Address - Zip Code:04739-0310
Practice Address - Country:US
Practice Address - Phone:207-444-5152
Practice Address - Fax:207-444-6099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102850401Medicaid
ME102850200Medicaid