Provider Demographics
NPI:1700060753
Name:TEDFORD HOUSING
Entity Type:Organization
Organization Name:TEDFORD HOUSING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KNISELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-729-1161
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0958
Mailing Address - Country:US
Mailing Address - Phone:207-729-1161
Mailing Address - Fax:207-725-7626
Practice Address - Street 1:34 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1522
Practice Address - Country:US
Practice Address - Phone:207-729-1161
Practice Address - Fax:207-725-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management