Provider Demographics
NPI:1366879157
Name:BACK TO BASICS CHILDCARE CENTER, INC.
Entity type:Organization
Organization Name:BACK TO BASICS CHILDCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GROVER
Authorized Official - Suffix:
Authorized Official - Credentials:CDA
Authorized Official - Phone:207-651-8538
Mailing Address - Street 1:44 DEPOT RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:ME
Mailing Address - Zip Code:04027-3347
Mailing Address - Country:US
Mailing Address - Phone:207-457-1838
Mailing Address - Fax:207-457-6056
Practice Address - Street 1:44 DEPOT RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:ME
Practice Address - Zip Code:04027-3347
Practice Address - Country:US
Practice Address - Phone:207-457-1838
Practice Address - Fax:207-457-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-11
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME391616252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME=========00Medicaid