Provider Demographics
NPI:1922170901
Name:EASTER SEALS MAINE, INC
Entity Type:Organization
Organization Name:EASTER SEALS MAINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TREANOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-621-3462
Mailing Address - Street 1:555 AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-4803
Mailing Address - Country:US
Mailing Address - Phone:603-623-8863
Mailing Address - Fax:603-622-8101
Practice Address - Street 1:14 ATLANTIC PL
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-2316
Practice Address - Country:US
Practice Address - Phone:207-560-2894
Practice Address - Fax:207-773-1139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251300000XAgenciesLocal Education Agency (LEA)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME191720000Medicaid
ME191720001Medicaid
ME0921635002OtherCIGNA
ME1341145OtherAETNA
ME191720100Medicaid
MEAA16930OtherHARVARD PILGRIM HEALTHCAR
ME191720200Medicaid