Basic Information
| Provider Information | |||||||||
| NPI: | 1316697154 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACOPEE VALLEY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PORTER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040683527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076258126 | ||||||||
| FaxNumber: | 2076257820 | ||||||||
| Practice Location | |||||||||
| Address1: | 202 MAPLE ST STE E | ||||||||
| Address2: | |||||||||
| City: | CORNISH | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040203147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076258126 | ||||||||
| FaxNumber: | 2076257820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2022 | ||||||||
| LastUpdateDate: | 05/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | EASTMAN | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | LEE | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 2076258126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.