Provider Demographics
NPI:1013960673
Name:MONMOUTH RESCUE ASSOCIATION, INC
Entity Type:Organization
Organization Name:MONMOUTH RESCUE ASSOCIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-933-6727
Mailing Address - Street 1:PO BOX 1810
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-1810
Mailing Address - Country:US
Mailing Address - Phone:207-892-0020
Mailing Address - Fax:207-893-0583
Practice Address - Street 1:847 MAIN ST
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04259
Practice Address - Country:US
Practice Address - Phone:207-933-2615
Practice Address - Fax:207-933-6458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME4733416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME590009753OtherRAIL ROAD MEDICARE
ME109720000Medicaid
ME007010OtherBLUE CROSS
ME705548Medicare ID - Type Unspecified