| Northern Lighthouse Inc. | |
|
14 Main St Mars Hill ME 04758 | |
| (207) 425-3880 | |
| Not Available |
| Full Name | Northern Lighthouse Inc. |
|---|---|
| Speciality | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |
| Location | 14 Main St, Mars Hill, Maine |
| Authorized Official Name and Position | Scott Alan Cray (HUMAN RESOURCE ADMIN) |
| Authorized Official Contact | 2075545114 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Northern Lighthouse Inc. Po Box 498 Mars Hill ME 04758-0498 Ph: (207) 425-3880 | Northern Lighthouse Inc. 14 Main St Mars Hill ME 04758 Ph: (207) 425-3880 |
| NPI Number | 1831311968 |
|---|---|
| Provider Enumeration Date | 05/02/2007 |
| Last Update Date | 02/04/2015 |
| Medicare PECOS PAC ID | 2769611805 |
|---|---|
| Medicare Enrollment ID | O20141016000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831311968 | NPI | - | NPPES |
| 135580000 | Medicaid | ME | |
| 432482300 | Medicaid | ME | |
| 1355800001 | Medicaid | ME | |
| 135580100 | Medicaid | ME |
| Provider Name | Theresa Flannery-blachura |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1154448785 PECOS PAC ID: 1153492004 Enrollment ID: I20080619000564 |
| Provider Name | Angela M Burlock |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417283375 PECOS PAC ID: 1951565084 Enrollment ID: I20120621000015 |
| Provider Name | Jennifer M Crandall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073671046 PECOS PAC ID: 1153573209 Enrollment ID: I20121218000447 |
| Provider Name | Loida E Ruane |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1205010717 PECOS PAC ID: 1355570144 Enrollment ID: I20140127000104 |