NPIMap

Organization Active NPI

Spruce Run - TH Program

  • Case Management Agency
  • Bangor, ME
National Provider Identifier
1619114634
Registry record updated Jan 13, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
SPRUCE RUN - TH PROGRAM
Practice address
77 Essex
Bangor, ME 04402
Phone
(207) 945-5102
Fax
(207) 990-4252
NPI assigned
Jan 13, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2009

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

Authorized official

Name
Dorathy Martel
Title
Grants
Phone
(207) 945-5102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

77 Essex
Bangor, ME 04402

Mailing address

P.O. Box 653
Bangor, ME 04402-0653
Phone (207) 945-5102

Other identifiers 1

IdentifierTypeStateIssuer
432212700MedicaidME

National Provider Directory

National Provider Directory
Tax ID family
Spruce Run - TH Program2 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": "1231804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231804800000",
    "number": "1619114634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 653",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044020653",
            "telephone_number": "207-945-5102",
            "fax_number": "207-990-4252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 ESSEX",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "04402",
            "telephone_number": "207-945-5102",
            "fax_number": "207-990-4252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPRUCE RUN - TH PROGRAM",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-13",
        "last_updated": "2009-01-13",
        "status": "A",
        "authorized_official_last_name": "MARTEL",
        "authorized_official_first_name": "DORATHY",
        "authorized_official_title_or_position": "GRANTS",
        "authorized_official_telephone_number": "207-945-5102"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "432212700",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; 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.