Provider Demographics
NPI:1710124599
Name:WILLIAM MIRO,
Entity Type:Organization
Organization Name:WILLIAM MIRO,
Other - Org Name:PCS FAMILY HOMES,
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:MIRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-883-2611
Mailing Address - Street 1:31 OLD BLUE POINT RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9608
Mailing Address - Country:US
Mailing Address - Phone:207-883-2611
Mailing Address - Fax:207-883-8611
Practice Address - Street 1:636 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9700
Practice Address - Country:US
Practice Address - Phone:207-883-2611
Practice Address - Fax:207-883-2611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME320600000X320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities