Provider Demographics
NPI:1902043839
Name:CENTRAL AROOSTOOK ASSOCIATION
Entity Type:Organization
Organization Name:CENTRAL AROOSTOOK ASSOCIATION
Other - Org Name:CENTRAL AROOSTOOK ARC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-764-0134
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-1245
Mailing Address - Country:US
Mailing Address - Phone:207-764-0134
Mailing Address - Fax:207-764-5543
Practice Address - Street 1:25 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2447
Practice Address - Country:US
Practice Address - Phone:207-764-0134
Practice Address - Fax:207-764-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME102910104OtherMAINECARE PROVIDER ID#
ME102910000OtherMAINECARE PROVIDER ID#
ME102910102OtherMAINECARE PROVIDER ID#
ME431595700OtherMAINECARE PROVIDER BILLING ID#
ME102910101OtherMAINECARE PROVIDER ID#
ME102910200OtherMINECARE PROVIDER ID#
ME102910100OtherMAINECARE PROVIDER ID#
ME102910001OtherMAINECARE PROVIDER ID#
ME102910105OtherMAINECARE PROVIDER ID#
ME432812600OtherMIANECARE PROVIDER ID#