Provider Demographics
NPI:1023082385
Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Entity type:Organization
Organization Name:HEALTHREACH COMMUNITY HEALTH CENTERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-872-5610
Mailing Address - Street 1:25 DEPOT ST
Mailing Address - Street 2:
Mailing Address - City:KINGFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04947-4208
Mailing Address - Country:US
Mailing Address - Phone:207-265-4555
Mailing Address - Fax:207-265-5004
Practice Address - Street 1:25 DEPOT ST
Practice Address - Street 2:
Practice Address - City:KINGFIELD
Practice Address - State:ME
Practice Address - Zip Code:04947-4208
Practice Address - Country:US
Practice Address - Phone:207-265-4555
Practice Address - Fax:207-265-5004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEE58728261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME137970102Medicaid
ME137970102Medicaid
MECA2004Medicare PIN
ME201810Medicare Oscar/Certification