PORT RESOURCES NPI 1053467779

NPI Information

PORT RESOURCES is a residential treatment facility, intellectual and/or developmental disabilities in South Portland, ME. The provider is a residential facility that provides habilitation services and other care and treatment to adults or children diagnosed with developmental and intellectual disabilities and are not able to live independently. PORT RESOURCES NPI is 1053467779. The provider is registered as an organization entity type.

The provider's business location address is:

280B GANNETT DR
SOUTH PORTLAND, ME
ZIP 04106-940
Phone: (207) 828-0048
Fax: (207) 772-3743

The provider's authorized official is Robin Defreest .
The authorized official title is Director Of Finance and has the following contact phone number (207) 828-0048.

The CLIA number assigned to this NPI record is 20D2207557 - mobile laboratory with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/26/2007 and was last updated on 7/16/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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