Provider Demographics
NPI:1134196124
Name:PARK STREET GROUP INC
Entity type:Organization
Organization Name:PARK STREET GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-594-4985
Mailing Address - Street 1:58 PARK ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841
Mailing Address - Country:US
Mailing Address - Phone:207-594-4985
Mailing Address - Fax:207-594-4974
Practice Address - Street 1:58 PARK ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841
Practice Address - Country:US
Practice Address - Phone:207-594-4985
Practice Address - Fax:207-594-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME100360000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty