Provider Demographics
NPI:1922218593
Name:OPPORTUNITY FARM FOR BOYS & GIRLS
Entity Type:Organization
Organization Name:OPPORTUNITY FARM FOR BOYS & GIRLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-926-4532
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:NEW GLOUCESTER
Mailing Address - State:ME
Mailing Address - Zip Code:04260-0065
Mailing Address - Country:US
Mailing Address - Phone:207-926-4532
Mailing Address - Fax:207-926-4529
Practice Address - Street 1:215 GLOUCESTER HILL ROAD
Practice Address - Street 2:
Practice Address - City:NEW GLOUCESTER
Practice Address - State:ME
Practice Address - Zip Code:04260
Practice Address - Country:US
Practice Address - Phone:207-926-4532
Practice Address - Fax:207-926-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME484744177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes177F00000XOther Service ProvidersLodgingGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102190000Medicaid