Provider Demographics
NPI:1922234053
Name:RELATIVES AND FRIENDS FOR SUPPORT, INC.
Entity Type:Organization
Organization Name:RELATIVES AND FRIENDS FOR SUPPORT, INC.
Other - Org Name:SEVENTY SIX BRADLEY STREET
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-784-6995
Mailing Address - Street 1:47 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-6844
Mailing Address - Country:US
Mailing Address - Phone:207-784-6995
Mailing Address - Fax:207-784-2398
Practice Address - Street 1:76 BRADLEY STREET
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-784-6995
Practice Address - Fax:207-784-2398
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELATIVES AND FRIENDS FOR SUPPORT, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS 27613104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME164460001Medicaid