Provider Demographics
NPI:1760923296
Name:THATCHER BROOK CENTER
Entity Type:Organization
Organization Name:THATCHER BROOK CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BROOK
Authorized Official - Last Name:WILBUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-907-9517
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:638 ELM STREET
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-0516
Mailing Address - Country:US
Mailing Address - Phone:207-907-9517
Mailing Address - Fax:
Practice Address - Street 1:638 ELM ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-4415
Practice Address - Country:US
Practice Address - Phone:207-907-9517
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services