Provider Demographics
NPI:1730318007
Name:PENNY A. PURINGTON
Entity Type:Organization
Organization Name:PENNY A. PURINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PURINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-582-5671
Mailing Address - Street 1:23 PURINGTONS LANE
Mailing Address - Street 2:
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345
Mailing Address - Country:US
Mailing Address - Phone:207-582-5671
Mailing Address - Fax:
Practice Address - Street 1:23 PURINGTONS LANE
Practice Address - Street 2:
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345
Practice Address - Country:US
Practice Address - Phone:207-582-5671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-08
Last Update Date:2009-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3001861320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities