Basic Information
| Provider Information | |||||||||
| NPI: | 1487885976 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SWEETSER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 MOODY ST | ||||||||
| Address2: | |||||||||
| City: | SACO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040721536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004343000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 50 MOODY ST | ||||||||
| Address2: | |||||||||
| City: | SACO | ||||||||
| State: | ME | ||||||||
| PostalCode: | 040721536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8004343000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2009 | ||||||||
| LastUpdateDate: | 10/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | TAYLOR | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 2072944651 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 320900000X | N | Residential Treatment Facilities | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 320800000X | Y | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness |
ID Information
| ID | Type | State | Issuer | Description | 102010017,102010020 | 05 | ME | MEDICAID | 102010036,1020101002 | 05 | ME | MEDICAID | 102010037,102010019 | 05 | ME | MEDICAID | 102010037,102010035 | 05 | ME | MEDICAID | 102010009,102010019 | 05 | ME | MEDICAID | 102010018,102010020 | 05 | ME | MEDICAID | 102010036,102010034 | 05 | ME | MEDICAID |