Provider Demographics
NPI:1710216510
Name:CRAYON COUNTRY PRESCHOOL
Entity Type:Organization
Organization Name:CRAYON COUNTRY PRESCHOOL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURNIER
Authorized Official - Suffix:
Authorized Official - Credentials:BA ECSE
Authorized Official - Phone:207-897-4555
Mailing Address - Street 1:455 E JAY RD
Mailing Address - Street 2:
Mailing Address - City:JAY
Mailing Address - State:ME
Mailing Address - Zip Code:04239-4607
Mailing Address - Country:US
Mailing Address - Phone:207-897-4555
Mailing Address - Fax:
Practice Address - Street 1:455 E JAY RD
Practice Address - Street 2:
Practice Address - City:JAY
Practice Address - State:ME
Practice Address - Zip Code:04239-4607
Practice Address - Country:US
Practice Address - Phone:207-897-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-08
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME416192222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213610000Medicaid