NPIMap

Organization Active NPI

63 Washington Street

  • Mental Illness Community Based Residential Treatment Facility
  • Camden, ME
National Provider Identifier
1245528314
Registry record updated Jul 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Illness Community Based Residential Treatment FacilityTaxonomy code 320800000X
License
ALLS 4136 Issued in ME
Legal business name
63 WASHINGTON STREET
Practice address
63 Washington St
Camden, ME 04843-1581
Phone
(207) 236-3638
Fax
(207) 236-3638
NPI assigned
Jul 11, 2011
Last updated
Jul 11, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Theresa K Willey
Title
Administrator
Phone
(207) 236-3638

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Illness Community Based Residential Treatment Facility 320800000X ALLS 4136 ME Primary

Addresses

Primary practice location

63 Washington St
Camden, ME 04843-1581

Mailing address

63 Washington Street
Camden, ME 04843
Phone (207) 236-3638

National Provider Directory

National Provider Directory
Tax ID family
63 Washington Street2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1310342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310342400000",
    "number": "1245528314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63 WASHINGTON STREET",
            "city": "CAMDEN",
            "state": "ME",
            "postal_code": "04843",
            "telephone_number": "207-236-3638",
            "fax_number": "207-236-3638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63 WASHINGTON ST",
            "city": "CAMDEN",
            "state": "ME",
            "postal_code": "048431581",
            "telephone_number": "207-236-3638",
            "fax_number": "207-236-3638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "63 WASHINGTON STREET",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-11",
        "last_updated": "2011-07-11",
        "status": "A",
        "authorized_official_last_name": "WILLEY",
        "authorized_official_first_name": "THERESA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "207-236-3638",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "ME",
            "license": "ALLS 4136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Camden, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.