Basic Information
| Provider Information | |||||||||
| NPI: | 1952470411 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SACOPEE VALLEY HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 777 | ||||||||
| Address2: | |||||||||
| City: | PARSONSFIELD | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040470777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076258126 | ||||||||
| FaxNumber: | 2076257820 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | PORTER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040683527 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2076258126 | ||||||||
| FaxNumber: | 2076257820 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2006 | ||||||||
| LastUpdateDate: | 10/05/2010 | ||||||||
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| AuthorizedOfficialLastName: | GILLMAN | ||||||||
| AuthorizedOfficialFirstName: | MARYAGNES | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2076258126 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
ID Information
| ID | Type | State | Issuer | Description | 999909028 | 05 | ME | MEDICAID |