MAINE RESOURCE DEVELOPMENT CORP NPI 1770722902

NPI Information

NPI: 1770722902
Provider Name: MAINE RESOURCE DEVELOPMENT CORP
Classification: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities - 320900000X
Entity Type: Organization
Address:
18 LINCOLN ST
PORTLAND, ME
ZIP 04103
Phone: (207) 774-2552
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MAINE RESOURCE DEVELOPMENT CORP is a community based residential treatment facility, intellectual and/or developmental disabilities in Portland, ME. The provider is a home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with mental retardation and/or developmental disabilities. MAINE RESOURCE DEVELOPMENT CORP NPI is 1770722902. The provider is registered as an organization entity type.

The provider's business location address is:

18 LINCOLN ST
PORTLAND, ME
ZIP 04103-408
Phone: (207) 774-2552

The provider's authorized official is Jerry Bruce Keene .
The authorized official title is Administrator and has the following contact phone number (207) 774-2552.

The enumeration date for this NPI number is 2/11/2009 and was last updated on 2/11/2009.

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:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	320600000X	Residential Treatment Facility, Intellectual and/or Developmental Disabilities		ALLS3219	MAINE	No
2	320900000X	Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities		ALLS3219	MAINE	Yes

Other Identifiers

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

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	109270000	MEDICAID	MAINE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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