Provider Demographics
NPI:1013151190
Name:FAMILY VIOLENCE PROJECT - T HOUSE
Entity Type:Organization
Organization Name:FAMILY VIOLENCE PROJECT - T HOUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-623-8637
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-0304
Mailing Address - Country:US
Mailing Address - Phone:207-623-8637
Mailing Address - Fax:207-621-6372
Practice Address - Street 1:35 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-4008
Practice Address - Country:US
Practice Address - Phone:207-623-8637
Practice Address - Fax:207-621-6372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109610001Medicaid