Provider Demographics
NPI:1851856397
Name:LASHELBRAYCM
Entity Type:Organization
Organization Name:LASHELBRAYCM
Other - Org Name:LASHELBRAYCM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE ADM
Authorized Official - Prefix:
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-505-8603
Mailing Address - Street 1:99 BACK SEARSPORT RD
Mailing Address - Street 2:
Mailing Address - City:SEARSPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04974-3627
Mailing Address - Country:US
Mailing Address - Phone:207-930-9465
Mailing Address - Fax:207-548-4201
Practice Address - Street 1:99 BACK SEARSPORT RD
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974
Practice Address - Country:US
Practice Address - Phone:207-930-9465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health