Provider Demographics
NPI:1952548943
Name:NORTH STAR FARM INC.
Entity Type:Organization
Organization Name:NORTH STAR FARM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:207-793-6612
Mailing Address - Street 1:PO BOX 54
Mailing Address - Street 2:
Mailing Address - City:N WATERBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04061-0054
Mailing Address - Country:US
Mailing Address - Phone:207-793-6612
Mailing Address - Fax:
Practice Address - Street 1:112 THYNGS MILL ROAD
Practice Address - Street 2:
Practice Address - City:NO WATERBORO
Practice Address - State:ME
Practice Address - Zip Code:04061
Practice Address - Country:US
Practice Address - Phone:207-793-6612
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-13
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME400986320800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME424030000Medicaid