NPI 1174734586

Northern Maine General

Organisation Intellectual and/or Developmental Disabilities Residential Treatment Facility Eagle Lake, ME

Practice location

Address: 36 Makayla Dr, Eagle Lake, ME 04739-0310
Phone: (207) 444-5152
Fax: (207) 444-6099
Mailing address: PO Box 310, Eagle Lake, ME 04739-0310

Authorised official

Name: Reynold Raymond
Title: Chief Executive Officer
Phone: (207) 444-5152

Registered specialties

Intellectual and/or Developmental Disabilities Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320600000X Licence ALLS 2221 (ME)

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Registry record

NPI: 1174734586
Entity type: Organization
NPI issued: 25 May 2007
Record last updated: 22 Aug 2020

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.