Provider Demographics
NPI:1932349107
Name:MAINE RESOURCE DEVELOPMENT CORPORATION
Entity Type:Organization
Organization Name:MAINE RESOURCE DEVELOPMENT CORPORATION
Other - Org Name:MAINE RESOURCE DEVELOPMENT CORPORATION INDEPENDENT LIVING PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:HURD
Authorized Official - Suffix:
Authorized Official - Credentials:BA, DSP
Authorized Official - Phone:207-772-1698
Mailing Address - Street 1:222 SAINT JOHN ST
Mailing Address - Street 2:SUITE 233
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3041
Mailing Address - Country:US
Mailing Address - Phone:207-772-1698
Mailing Address - Fax:207-347-8089
Practice Address - Street 1:222 SAINT JOHN ST
Practice Address - Street 2:SUITE 233
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3041
Practice Address - Country:US
Practice Address - Phone:207-772-1698
Practice Address - Fax:207-347-8089
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAINE RESOURCE DEVELOPMENT CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-02
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME109270100Medicaid