Provider Demographics
NPI:1669415659
Name:HARBOR SCHOOLS OF MAINE, INC.
Entity type:Organization
Organization Name:HARBOR SCHOOLS OF MAINE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZZOTTI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-798-5448
Mailing Address - Street 1:63 ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086-1424
Mailing Address - Country:US
Mailing Address - Phone:207-798-5448
Mailing Address - Fax:207-798-5449
Practice Address - Street 1:1152 ROCKLAND ST.
Practice Address - Street 2:
Practice Address - City:W. ROCKPORT
Practice Address - State:ME
Practice Address - Zip Code:04865
Practice Address - Country:US
Practice Address - Phone:207-236-6179
Practice Address - Fax:207-236-6189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME468097322D00000X
ME389572322D00000X
ME374541322D00000X
ME403466322D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes322D00000XResidential Treatment FacilitiesResidential Treatment Facility, Emotionally Disturbed Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME132710001Medicaid
ME132710002Medicaid
ME132710004Medicaid
ME132710005Medicaid
ME132710000Medicaid
ME132710003Medicaid
ME132710006Medicaid