NPIMap

Organization Active NPI

Kidspeace National Centers of New England Inc

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Ellsworth, ME
National Provider Identifier
1700958022
Registry record updated Jul 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emotionally Disturbed Childrens' Residential Treatment FacilityTaxonomy code 322D00000X
License
216402 Issued in ME
Legal business name
KIDSPEACE NATIONAL CENTERS OF NEW ENGLAND INC
Practice address
16 Kidspeace Way
Graham Lake Campus
Ellsworth, ME 04605
Phone
(207) 667-0909
Fax
(207) 667-6348
NPI assigned
Nov 14, 2006
Last updated
Jul 18, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2008

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

Authorized official

Name
Mr. Michael W Slack
Title
VP for Marketing and Business Devel
Phone
(800) 854-3123

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X 216402 ME Primary

Addresses

Primary practice location

16 Kidspeace Way
Graham Lake Campus
Ellsworth, ME 04605

Mailing address

4085 Independence Dr
Schnecksville, PA 18078-2574
Phone (800) 854-3123

Other identifiers 3

IdentifierTypeStateIssuer
30833999MedicaidNH
123430001MedicaidME
58580MedicaidCT

National Provider Directory

National Provider Directory
Tax ID family
Kidspeace National Centers of New England Inc46 organizations share this tax ID, including this one

Other organizations with this tax ID 45

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

View all 45

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216339200000",
    "number": "1700958022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4085 INDEPENDENCE DR",
            "city": "SCHNECKSVILLE",
            "state": "PA",
            "postal_code": "180782574",
            "telephone_number": "800-854-3123",
            "fax_number": "610-799-8318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 KIDSPEACE WAY",
            "address_2": "GRAHAM LAKE CAMPUS",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "04605",
            "telephone_number": "207-667-0909",
            "fax_number": "207-667-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDSPEACE NATIONAL CENTERS OF NEW ENGLAND INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-07-18",
        "status": "A",
        "authorized_official_last_name": "SLACK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "VP FOR MARKETING AND BUSINESS DEVEL",
        "authorized_official_telephone_number": "800-854-3123",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "322D00000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Emotionally Disturbed Children",
            "state": "ME",
            "license": "216402",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30833999",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123430001",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "58580",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ellsworth, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2008; 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.