Provider Demographics
NPI:1922071745
Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Other - Org Name:LOVEJOY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-5610
Mailing Address - Street 1:7 SCHOOL ST
Mailing Address - Street 2:STE 1
Mailing Address - City:ALBION
Mailing Address - State:ME
Mailing Address - Zip Code:04910
Mailing Address - Country:US
Mailing Address - Phone:207-437-9388
Mailing Address - Fax:207-437-2557
Practice Address - Street 1:7 SCHOOL ST
Practice Address - Street 2:STE 1
Practice Address - City:ALBION
Practice Address - State:ME
Practice Address - Zip Code:04910
Practice Address - Country:US
Practice Address - Phone:207-437-9388
Practice Address - Fax:207-437-2557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEE58728261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME137970103Medicaid
MECA2004Medicare PIN
ME201808Medicare Oscar/Certification
MM4666Medicare ID - Type Unspecified