Provider Demographics
NPI:1932351152
Name:THI OF MAINE
Entity Type:Organization
Organization Name:THI OF MAINE
Other - Org Name:MAINE CENTER FOR INTEGRATED REHAB
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GODDARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-989-2034
Mailing Address - Street 1:248 STATE ST
Mailing Address - Street 2:
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1519
Mailing Address - Country:US
Mailing Address - Phone:207-989-2034
Mailing Address - Fax:207-989-5971
Practice Address - Street 1:95 ROUTE 201
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3303
Practice Address - Country:US
Practice Address - Phone:207-453-1330
Practice Address - Fax:207-453-1333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP1885261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)