Provider Demographics
NPI:1255581666
Name:VICKI L. DOUGHERTY/ABLE TO STAY HOME CARE
Entity type:Organization
Organization Name:VICKI L. DOUGHERTY/ABLE TO STAY HOME CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-282-1699
Mailing Address - Street 1:209 MAIN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-1566
Mailing Address - Country:US
Mailing Address - Phone:207-282-1699
Mailing Address - Fax:207-282-1660
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1566
Practice Address - Country:US
Practice Address - Phone:207-282-1699
Practice Address - Fax:207-282-1660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2898251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME20-7074Medicare PIN