Provider Demographics
NPI:1851601421
Name:BOLDUC EMPLOYMENT SUPPORT & TRAINING, LLC
Entity Type:Organization
Organization Name:BOLDUC EMPLOYMENT SUPPORT & TRAINING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BOLDUC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-774-8700
Mailing Address - Street 1:175 LANCASTER STREET
Mailing Address - Street 2:SUITE 218A
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101
Mailing Address - Country:US
Mailing Address - Phone:207-774-8700
Mailing Address - Fax:207-774-8700
Practice Address - Street 1:175 LANCASTER STREET
Practice Address - Street 2:SUITE 218A
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101
Practice Address - Country:US
Practice Address - Phone:207-774-8700
Practice Address - Fax:207-774-8700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services