Provider Demographics
NPI:1821389479
Name:CONSTELLATIONS
Entity Type:Organization
Organization Name:CONSTELLATIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:RUTBERG
Authorized Official - Suffix:
Authorized Official - Credentials:D H ED
Authorized Official - Phone:207-645-7010
Mailing Address - Street 1:284 MAIN ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:WILTON
Mailing Address - State:ME
Mailing Address - Zip Code:04294-3044
Mailing Address - Country:US
Mailing Address - Phone:207-645-7010
Mailing Address - Fax:207-645-7141
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:SUITE 190
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3044
Practice Address - Country:US
Practice Address - Phone:207-645-7010
Practice Address - Fax:207-645-7141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management