Provider Demographics
NPI:1336380443
Name:OUELLETTE FOSTER HOME
Entity Type:Organization
Organization Name:OUELLETTE FOSTER HOME
Other - Org Name:ARMAND L OUELLETTE JR.
Other - Org Type:Other Name
Authorized Official - Title/Position:FOSTER HOME OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARMAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:OUELLETTE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:207-868-5881
Mailing Address - Street 1:P.O. BOX 101
Mailing Address - Street 2:162 STATE STREET
Mailing Address - City:VAN BUREN
Mailing Address - State:ME
Mailing Address - Zip Code:04785-1446
Mailing Address - Country:US
Mailing Address - Phone:207-868-5881
Mailing Address - Fax:
Practice Address - Street 1:162 STATE STREET
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:ME
Practice Address - Zip Code:04785
Practice Address - Country:US
Practice Address - Phone:207-868-5881
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME201940000Medicaid