Provider Demographics
NPI:1740415488
Name:THE SHOOTING STARS PROGRAM
Entity Type:Organization
Organization Name:THE SHOOTING STARS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:207-883-5882
Mailing Address - Street 1:27 HIGH POINT RD
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-9027
Mailing Address - Country:US
Mailing Address - Phone:207-883-8095
Mailing Address - Fax:
Practice Address - Street 1:152 US ROUTE 1
Practice Address - Street 2:4
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-8365
Practice Address - Country:US
Practice Address - Phone:207-883-5882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2009-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME217310000OtherMAINECARE IDENTIFICATION NUMBER