Provider Demographics
NPI:1053600965
Name:HEALTHREACH CHC
Entity type:Organization
Organization Name:HEALTHREACH CHC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-861-3407
Mailing Address - Street 1:10 WATER ST
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6559
Mailing Address - Country:US
Mailing Address - Phone:207-861-3449
Mailing Address - Fax:207-861-3436
Practice Address - Street 1:4 CLEMENT WAY
Practice Address - Street 2:
Practice Address - City:BELGRADE LAKES
Practice Address - State:ME
Practice Address - Zip Code:04918
Practice Address - Country:US
Practice Address - Phone:207-861-3449
Practice Address - Fax:207-861-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-31
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)