Provider Demographics
NPI:1487987558
Name:BOURQUE, ANNE M
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:M
Last Name:BOURQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LEDGE HILL WAY
Mailing Address - Street 2:
Mailing Address - City:WEST GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-3135
Mailing Address - Country:US
Mailing Address - Phone:207-582-3146
Mailing Address - Fax:
Practice Address - Street 1:22 LEDGE HILL WAY
Practice Address - Street 2:
Practice Address - City:WEST GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-3135
Practice Address - Country:US
Practice Address - Phone:207-582-3146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities