Provider Demographics
NPI:1265523559
Name:BELFAST PUBLIC HEALTH NURSING
Entity type:Organization
Organization Name:BELFAST PUBLIC HEALTH NURSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIBBETTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-338-2500
Mailing Address - Street 1:119 NORTHPORT AVE
Mailing Address - Street 2:P.O. BOX 287
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6069
Mailing Address - Country:US
Mailing Address - Phone:207-338-3368
Mailing Address - Fax:207-338-9368
Practice Address - Street 1:119 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6069
Practice Address - Country:US
Practice Address - Phone:207-338-3368
Practice Address - Fax:207-338-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management