Basic Information
| Provider Information | |||||||||
| NPI: | 1164484093 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DAY ONE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 MAIN ST. | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077670991 | ||||||||
| FaxNumber: | 2077670995 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH PORTLAND | ||||||||
| State: | ME | ||||||||
| PostalCode: | 041065462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077670991 | ||||||||
| FaxNumber: | 2077670995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/05/2006 | ||||||||
| LastUpdateDate: | 04/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | TANGUAY | ||||||||
| AuthorizedOfficialFirstName: | SHERRY | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | BILLING | ||||||||
| AuthorizedOfficialTelephone: | 2077670991 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM0855X | 227222 | ME | N | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | 261QR0405X | 221141 | ME | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 3245S0500X | 212936 | ME | Y | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children |
ID Information
| ID | Type | State | Issuer | Description | 106120100 | 05 | ME | MEDICAID | 106120201 | 05 | ME | MEDICAID | 106120001 | 05 | ME | MEDICAID | 106120000 | 05 | ME | MEDICAID | 106120102 | 05 | ME | MEDICAID | 106120200 | 05 | ME | MEDICAID | 106120101 | 05 | ME | MEDICAID |