Provider Demographics
NPI:1952531113
Name:ARRIAN MYRICK STOCKDELL
Entity Type:Organization
Organization Name:ARRIAN MYRICK STOCKDELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MYRICK STOCKDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-588-7002
Mailing Address - Street 1:78 PINE ST
Mailing Address - Street 2:
Mailing Address - City:ORONO
Mailing Address - State:ME
Mailing Address - Zip Code:04473-4055
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 HERRICK RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:ME
Practice Address - Zip Code:04617-3746
Practice Address - Country:US
Practice Address - Phone:207-359-8338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-22
Last Update Date:2009-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care