Provider Demographics
NPI:1740414408
Name:HARBOR SCHOOLS OF MAINE, INC.
Entity Type:Organization
Organization Name:HARBOR SCHOOLS OF MAINE, INC.
Other - Org Name:HARBOR FAMILY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-798-5448
Mailing Address - Street 1:63 ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1424
Mailing Address - Country:US
Mailing Address - Phone:207-725-6505
Mailing Address - Fax:207-798-5449
Practice Address - Street 1:247 COMMERCIAL ST
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04856-5964
Practice Address - Country:US
Practice Address - Phone:207-470-7090
Practice Address - Fax:207-470-7094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME582781251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432322501Medicaid