Provider Demographics
NPI:1144727587
Name:MELISSA MOORE FOUNDATION FOR HEALTH AND WELLBEING
Entity type:Organization
Organization Name:MELISSA MOORE FOUNDATION FOR HEALTH AND WELLBEING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAGNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-651-0783
Mailing Address - Street 1:237 STONE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:ME
Mailing Address - Zip Code:04048-3910
Mailing Address - Country:US
Mailing Address - Phone:207-651-0783
Mailing Address - Fax:
Practice Address - Street 1:237 STONE HILL RD
Practice Address - Street 2:
Practice Address - City:LIMERICK
Practice Address - State:ME
Practice Address - Zip Code:04048-3910
Practice Address - Country:US
Practice Address - Phone:207-651-0783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health