Provider Demographics
NPI:1174763411
Name:CHILDREN'S CENTER: EARLY INTERVENTION AND FAMILY SUPPORT, INC.
Entity type:Organization
Organization Name:CHILDREN'S CENTER: EARLY INTERVENTION AND FAMILY SUPPORT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-626-3497
Mailing Address - Street 1:1 ALDEN AVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-6185
Mailing Address - Country:US
Mailing Address - Phone:207-626-3497
Mailing Address - Fax:207-621-6211
Practice Address - Street 1:1 ALDEN AVE
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-6185
Practice Address - Country:US
Practice Address - Phone:207-626-3497
Practice Address - Fax:207-621-6211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103730200Medicaid
ME103730000Medicaid
ME103730400Medicaid
ME103730300Medicaid
ME103730100Medicaid