Provider Demographics
NPI:1750670998
Name:REGIONAL EMPLOYEE ASSISTANCE PROGRAM INC
Entity Type:Organization
Organization Name:REGIONAL EMPLOYEE ASSISTANCE PROGRAM INC
Other - Org Name:ONE SOURCE HEATLH CENTER - SAN SABA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:PO BOX 8691
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8691
Mailing Address - Country:US
Mailing Address - Phone:325-372-5701
Mailing Address - Fax:325-372-3249
Practice Address - Street 1:403 W WALLACE ST
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-4433
Practice Address - Country:US
Practice Address - Phone:325-372-5701
Practice Address - Fax:325-372-3249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EMPLOYEE ASSISTANCE PROGRAM INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673900Medicare Oscar/Certification