Provider Demographics
NPI:1003028192
Name:CITY OF BREWER
Entity type:Organization
Organization Name:CITY OF BREWER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DATA SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGERS-BLANCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-989-8638
Mailing Address - Street 1:79 PARKWAY SOUTH
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412
Mailing Address - Country:US
Mailing Address - Phone:207-989-8636
Mailing Address - Fax:207-989-8651
Practice Address - Street 1:261 CENTER ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1900
Practice Address - Country:US
Practice Address - Phone:207-989-8638
Practice Address - Fax:207-989-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1003028192Medicaid