YOUTH ALTERNATIVES INGRAHAM - NPI NUMBER 1326274622

Summary

Provider Name: YOUTH ALTERNATIVES INGRAHAM

NPI Number: 1326274622

Clasification: Case Management (251B00000X)

Address:
50 LYDIA LN
SOUTH PORTLAND, ME
ZIP 04106

Phone Number: (207) 874-1175



Detailed Information

YOUTH ALTERNATIVES INGRAHAM is a case management in South Portland, ME. The provider is an organization that is responsible for providing case management services. The agency provides services which assist an individual in gaining access to needed medical, social, educational, and/or other services. Case management services may be used to locate, coordinate, and monitor necessary appropriate services. It may be used to encourage the use of cost-effective medical care by referrals to appropriate providers and to discourage over utilization of costly services. Case management may also serve to provide necessary coordination of non-medical services such as vocational rehabilitation, education, employment, when the services provided enable the individual to function at the highest level. The assigned NPI number for this provider is 1326274622 and is registered as an organization entity type.

The provider's business address is:

50 LYDIA LN
SOUTH PORTLAND, ME
ZIP 04106-156
Phone: (207) 874-1175
Fax: (207) 874-1181

The provider's authorized official is Virginia Gentile .
The authorized official title is Chief Financial Officer and has the following contact phone number (207) 874-1175.

The enumeration date for this NPI number is 6/2/2009 and was last updated on 3/23/2010.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 251B00000X Case Management Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 105460010 MEDICAID ME
2 105460005 MEDICAID ME
3 105460000 MEDICAID ME
4 105460011 MEDICAID ME
5 105460008 MEDICAID ME

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1326274622 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name YOUTH ALTERNATIVES INGRAHAM The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 50 LYDIA LN The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Business Practice Location Address City Name SOUTH PORTLAND The city name in the location address of the provider being identified.
7 Provider Business Practice Location Address State Name ME The State code in the location of the provider being identified.
8 Provider Business Practice Location Address Postal Code 041062156 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
9 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
10 Provider Business Practice Location Address Telephone Number 2078741175 The telephone number associated with the location address of the provider being identified.
11 Provider Business Practice Location Address Fax Number 2078741181 The fax number associated with the location address of the provider being identified.
12 Provider Enumeration Date 6/2/2009 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 3/23/2010 The date that a record was last updated or changed.
14 Authorized Official Last Name GENTILE The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name VIRGINIA The first name of the authorized official.
16 Authorized Official Title or Position CHIEF FINANCIAL OFFICER The title or position of the authorized official.
17 Authorized Official Telephone Number 2078741175 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 251B00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 Y
20 Other Provider Identifier 1 105460010 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
21 Other Provider Identifier Type Code 1 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
22 Other Provider Identifier State 1 ME
23 Other Provider Identifier 2 105460005 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
24 Other Provider Identifier Type Code 2 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier State 2 ME
26 Other Provider Identifier 3 105460000 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
27 Other Provider Identifier Type Code 3 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
28 Other Provider Identifier State 3 ME
29 Other Provider Identifier 4 105460011 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier Type Code 4 05 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
31 Other Provider Identifier State 4 ME
32 Other Provider Identifier 5 105460008
33 Other Provider Identifier Type Code 5 05
34 Other Provider Identifier State 5 ME
35 Is Organization Subpart N

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This page was last updated on: 2/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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