NPI 1053467779

Port Resources

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility South Portland, ME

Practice location

Address: 280b Gannett Dr, South Portland, ME 04106-6940
Phone: (207) 828-0048
Fax: (207) 772-3743

Authorised official

Name: Robin Defreest
Title: Director of Finance
Phone: (207) 828-0048

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence 388111 (ME)

Other Residential Treatment Facility, Intellectual and/or Developmental Disabilities providers in Maine →

Registry record

NPI: 1053467779
Entity type: Organization
NPI issued: 26 Jan 2007
Record last updated: 16 Jul 2014

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.