Provider Demographics
NPI:1174769822
Name:GROUP MAIN STREAM INC.
Entity type:Organization
Organization Name:GROUP MAIN STREAM INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MACMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-523-5170
Mailing Address - Street 1:15 SAUNDERS WAY
Mailing Address - Street 2:SUITE 500G
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-4833
Mailing Address - Country:US
Mailing Address - Phone:207-523-5170
Mailing Address - Fax:207-854-1787
Practice Address - Street 1:15 SAUNDERS WAY
Practice Address - Street 2:SUITE 500G
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4833
Practice Address - Country:US
Practice Address - Phone:207-523-5170
Practice Address - Fax:207-854-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEALLS3183320900000X
MEALLS2704320900000X
MEALLS2706320900000X
MEALLS3093320900000X
MEALLS3094320900000X
MEALLS3206320900000X
MEALLS2699320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME111150003Medicaid
ME111150002Medicaid
ME111150001Medicaid
ME111150006Medicaid
ME111150000Medicaid
ME111150004Medicaid
ME111150005Medicaid